Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.52440
Jiayu Hou, Bailin Pan, Yinuo Chen, Yuanyuan Wang, Xu Chang, Tianpei Hong, Ye Liu
Importance: Little is known about how gender identity develops and how it affects gender-affirming hormone therapy (GAHT) utilization among transgender people in China.
Objective: To investigate gender identity development among Chinese transgender men (TM) and transgender women (TW) and to explore how identity-related factors are associated with GAHT utilization.
Design, setting, and participants: This cross-sectional study is based on the latest Chinese Transgender Health Survey targeting the transgender population in China conducted from May to December in 2021. Data analysis was completed in December 2024. Participants were recruited online via snowball sampling.
Main outcomes and measures: The primary outcomes are the timing of gender identity development milestones (first perception of gender incongruence, confirmation, disclosure, and initiating GAHT) and GAHT utilization status. Multivariable binary logistic regression identified factors associated with GAHT-related behaviors and feedback.
Results: A total of 4296 transgender people (1462 TM [34.0%] and 2834 TW [66.0%]; median [IQR] age, 21 [18-24] years) were included in the final analysis. The age distribution of first perceived gender incongruence exhibited a bimodal pattern, with peak occurrences at ages 5 to 6 and at 12 years. The median (IQR) ages at gender identity development milestones were all younger for TM than for TW: 6 (4-10) years vs 9 (6-12) years for perception, 14 (11-16) years vs 15 (12-17) years for confirmation, and 16 (14-19) years vs 17 (15-20) years for disclosure, whereas the age of initiating GAHT was older in TM than in TW (median [IQR] age, 19 [17-22] years vs 18 [16-21] years). The demand for GAHT (3759 participants [87.5%]), usage (2247 participants [52.3%]), and the rate of valid prescriptions among hormone users (339 participants [15.1%]) have all increased significantly compared with 2017. Being a TW and without a college education were associated with starting GAHT before age 16 years, while being a TM, having family disclosure of gender identity, and having official prescriptions were associated with positive feedback on GAHT.
Conclusions and relevance: In this cross-sectional study of Chinese TM and TW, gender identity development differed by gender, with TM recognizing incongruence earlier and TW progressing faster in initiating GAHT. Both groups showed strong demand for GAHT. Despite recent improvements in GAHT service accessibility, challenges persist in medical accessibility. These findings highlight the need for personalized support for transgender youths and underscore the importance of improving formal transgender health care services in China to enhance the well-being of this population.
{"title":"Gender Identity Milestones and Hormone Utilization in Transgender Men and Women in China.","authors":"Jiayu Hou, Bailin Pan, Yinuo Chen, Yuanyuan Wang, Xu Chang, Tianpei Hong, Ye Liu","doi":"10.1001/jamanetworkopen.2025.52440","DOIUrl":"10.1001/jamanetworkopen.2025.52440","url":null,"abstract":"<p><strong>Importance: </strong>Little is known about how gender identity develops and how it affects gender-affirming hormone therapy (GAHT) utilization among transgender people in China.</p><p><strong>Objective: </strong>To investigate gender identity development among Chinese transgender men (TM) and transgender women (TW) and to explore how identity-related factors are associated with GAHT utilization.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study is based on the latest Chinese Transgender Health Survey targeting the transgender population in China conducted from May to December in 2021. Data analysis was completed in December 2024. Participants were recruited online via snowball sampling.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes are the timing of gender identity development milestones (first perception of gender incongruence, confirmation, disclosure, and initiating GAHT) and GAHT utilization status. Multivariable binary logistic regression identified factors associated with GAHT-related behaviors and feedback.</p><p><strong>Results: </strong>A total of 4296 transgender people (1462 TM [34.0%] and 2834 TW [66.0%]; median [IQR] age, 21 [18-24] years) were included in the final analysis. The age distribution of first perceived gender incongruence exhibited a bimodal pattern, with peak occurrences at ages 5 to 6 and at 12 years. The median (IQR) ages at gender identity development milestones were all younger for TM than for TW: 6 (4-10) years vs 9 (6-12) years for perception, 14 (11-16) years vs 15 (12-17) years for confirmation, and 16 (14-19) years vs 17 (15-20) years for disclosure, whereas the age of initiating GAHT was older in TM than in TW (median [IQR] age, 19 [17-22] years vs 18 [16-21] years). The demand for GAHT (3759 participants [87.5%]), usage (2247 participants [52.3%]), and the rate of valid prescriptions among hormone users (339 participants [15.1%]) have all increased significantly compared with 2017. Being a TW and without a college education were associated with starting GAHT before age 16 years, while being a TM, having family disclosure of gender identity, and having official prescriptions were associated with positive feedback on GAHT.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of Chinese TM and TW, gender identity development differed by gender, with TM recognizing incongruence earlier and TW progressing faster in initiating GAHT. Both groups showed strong demand for GAHT. Despite recent improvements in GAHT service accessibility, challenges persist in medical accessibility. These findings highlight the need for personalized support for transgender youths and underscore the importance of improving formal transgender health care services in China to enhance the well-being of this population.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2552440"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12776202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.52870
Julian Brunner, Suzanne Morrissey, Elise M Stevens, Chína Payne, Scott Wiltz, Sarah L Cutrona, Seppo T Rinne
{"title":"Ambient Scribe Technology in Simulated Patient Encounters Across Specialties.","authors":"Julian Brunner, Suzanne Morrissey, Elise M Stevens, Chína Payne, Scott Wiltz, Sarah L Cutrona, Seppo T Rinne","doi":"10.1001/jamanetworkopen.2025.52870","DOIUrl":"10.1001/jamanetworkopen.2025.52870","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2552870"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.52825
Kathryn M Stephenson, Naomi R M Schwartz, Hannibal Person, Niviann Blondet, Maria E Benitez-Cortez, Mason Nuding, Stephanie A Kraft, David L Suskind
<p><strong>Importance: </strong>With the approval of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for pediatric obesity, families are increasingly considering pharmaceutical treatment alongside lifestyle optimization for their children, although how caregivers will make these decisions remains unexplored. This is especially important in contexts where food insecurity may limit the feasibility of lifestyle change and adjunct therapy could improve outcomes.</p><p><strong>Objective: </strong>To explore how caregivers make decisions regarding the inclusion of GLP-1 RAs for pediatric obesity treatment in the context of food insecurity.</p><p><strong>Design, setting, and participants: </strong>In this qualitative study, eligible participants were caregivers (aged ≥18 years) of children (aged <18 years) with obesity and metabolic dysfunction-associated steatotic liver disease who screened positive for moderate-severe food insecurity between July 1, 2022, and October 31, 2023. Caregivers were recruited from pediatric gastroenterology clinics of a regional academic health care system. Semistructured interviews via telephone or video were offered in participants' preferred language between December 1, 2023, and April 30, 2024.</p><p><strong>Main outcomes and measures: </strong>The main outcome was factors influencing caregiver decisions regarding medication use for their child's metabolic disease. Interview transcripts were translated to English as needed, then thematically analyzed inductively by 2 research investigators to identify themes within an array of caregivers' decision-making processes.</p><p><strong>Results: </strong>Of 37 eligible caregivers, 21 completed interviews, 20 of which were included in the analysis. Of the 20 caregiver participants (19 [95%] mothers; mean [SD] age, 40.5 [6.1] years), 18 (90%) were born outside the US, 13 (65%) had not completed high school, and 15 (75%) used a language other than English in clinical settings. Of the 20 child patients, 18 (90%) were male, and mean (SD) age at interview was 12.9 (2.9) years. All caregivers had received lifestyle-related recommendations from their child's physicians and had been referred to dietetics; 10 (50%) had met with a dietitian. Twelve (60%) desired adjunct pharmacotherapy for their child. Three common themes influenced caregiver decision-making about GLP-1 RA use: (1) prior experience with lifestyle change, (2) trust in the safety and efficacy of GLP-1 RAs, and (3) values regarding optimal care for children. An updated conceptual framework was applied to illustrate caregivers' decision-making.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study, children's caregivers experiencing food insecurity expressed interest in both lifestyle-only and medication-inclusive approaches, with decisions shaped by lived experience, perceptions of safety, and values. Shared decision-making conversations in clinical settings that acknowledge these influences-and ad
{"title":"Perceptions of GLP-1 RA Use for Children With Obesity Among Caregivers With Food Insecurity: A Qualitative Study.","authors":"Kathryn M Stephenson, Naomi R M Schwartz, Hannibal Person, Niviann Blondet, Maria E Benitez-Cortez, Mason Nuding, Stephanie A Kraft, David L Suskind","doi":"10.1001/jamanetworkopen.2025.52825","DOIUrl":"10.1001/jamanetworkopen.2025.52825","url":null,"abstract":"<p><strong>Importance: </strong>With the approval of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for pediatric obesity, families are increasingly considering pharmaceutical treatment alongside lifestyle optimization for their children, although how caregivers will make these decisions remains unexplored. This is especially important in contexts where food insecurity may limit the feasibility of lifestyle change and adjunct therapy could improve outcomes.</p><p><strong>Objective: </strong>To explore how caregivers make decisions regarding the inclusion of GLP-1 RAs for pediatric obesity treatment in the context of food insecurity.</p><p><strong>Design, setting, and participants: </strong>In this qualitative study, eligible participants were caregivers (aged ≥18 years) of children (aged <18 years) with obesity and metabolic dysfunction-associated steatotic liver disease who screened positive for moderate-severe food insecurity between July 1, 2022, and October 31, 2023. Caregivers were recruited from pediatric gastroenterology clinics of a regional academic health care system. Semistructured interviews via telephone or video were offered in participants' preferred language between December 1, 2023, and April 30, 2024.</p><p><strong>Main outcomes and measures: </strong>The main outcome was factors influencing caregiver decisions regarding medication use for their child's metabolic disease. Interview transcripts were translated to English as needed, then thematically analyzed inductively by 2 research investigators to identify themes within an array of caregivers' decision-making processes.</p><p><strong>Results: </strong>Of 37 eligible caregivers, 21 completed interviews, 20 of which were included in the analysis. Of the 20 caregiver participants (19 [95%] mothers; mean [SD] age, 40.5 [6.1] years), 18 (90%) were born outside the US, 13 (65%) had not completed high school, and 15 (75%) used a language other than English in clinical settings. Of the 20 child patients, 18 (90%) were male, and mean (SD) age at interview was 12.9 (2.9) years. All caregivers had received lifestyle-related recommendations from their child's physicians and had been referred to dietetics; 10 (50%) had met with a dietitian. Twelve (60%) desired adjunct pharmacotherapy for their child. Three common themes influenced caregiver decision-making about GLP-1 RA use: (1) prior experience with lifestyle change, (2) trust in the safety and efficacy of GLP-1 RAs, and (3) values regarding optimal care for children. An updated conceptual framework was applied to illustrate caregivers' decision-making.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study, children's caregivers experiencing food insecurity expressed interest in both lifestyle-only and medication-inclusive approaches, with decisions shaped by lived experience, perceptions of safety, and values. Shared decision-making conversations in clinical settings that acknowledge these influences-and ad","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2552825"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.49620
Julia E Szymczak, Valerie M Vaughn, Adam L Hersh
{"title":"Improving Discharge Antibiotic Use via Prospective Audit and Feedback-The Importance of Contextual Variation.","authors":"Julia E Szymczak, Valerie M Vaughn, Adam L Hersh","doi":"10.1001/jamanetworkopen.2025.49620","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.49620","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2549620"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.53712
Sarah Angelique Shi En Yip, Queena Zhi Xuan Lim, Gwyneth Kong, Zubair Amin, Yvonne Peng Mei Ng
<p><strong>Importance: </strong>Quality of life (QOL) of parents following the birth of a premature infant is substantially affected, necessitating a comprehensive understanding of its determinants to guide effective interventions.</p><p><strong>Objectives: </strong>To systematically assess QOL among parents of premature infants and to identify modifiable factors associated with their well-being.</p><p><strong>Data sources: </strong>PubMed, CINAHL, and Embase were searched from inception to October 5, 2025.</p><p><strong>Study selection: </strong>Cross-sectional studies, longitudinal cohort studies, and randomized clinical trials reporting quantitative QOL data using validated instruments were included.</p><p><strong>Data extraction and synthesis: </strong>The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Meta-analysis was performed using random-effects models. All studies underwent qualitative synthesis and quality appraisal. Data were extracted and quality was assessed by 2 independent reviewers.</p><p><strong>Main outcomes and measures: </strong>Meta-analysis was carried out on studies that used the World Health Organization QOL-Short Form (WHOQOL-BREF; range, 0-100, with higher scores indicating better QOL) and the 12-Item Short Form Health Survey (SF-12; mean score, 50, with higher scores indicating better QOL) to assess the QOL among parents of preterm children. Qualitative analysis was performed to compare QOL of parents following preterm and full-term births, fathers vs mothers, and by degree of prematurity. Modifiable factors associated with QOL were identified by synthesizing evidence from longitudinal cohort studies and randomized clinical trials.</p><p><strong>Results: </strong>A total of 34 studies, with 6617 parents of preterm children and 8295 parents of full-term children, were included. Meta-analysis of WHOQOL-BREF data (10 studies, 1147 parents of preterm children) showed pooled mean domain scores ranged from 63.63 (95% CI, 54.00-73.35) in the environmental domain to 66.68 (95% CI, 59.77-73.60) in the psychological well-being domain. Systematic review found that lower parental QOL was evident during infant hospitalization with improvement over time. Meta-analysis of SF-12 data (5 studies, 3137 parents) revealed pooled mean physical and mental component summary scores of 47.22 (95% CI, 40.06-54.39) and 44.58 (95% CI, 39.01-50.16), respectively. High heterogeneity reflected variability of infant maturity, assessment timing, and sociodemographic factors. Parents of preterm infants reported lower QOL than parents of full-term children in the early postpartum period, but this gap narrowed over time. Mothers reported poorer QOL compared with fathers during the infant's hospitalization, but the gap diminished by 4 to 6 months post partum. Key modifiable factors of QOL were parental psychological well-being, knowledge and empowerment, social and systemic support, and in
{"title":"Quality of Life of Parents of Premature Infants: A Systematic Review and Meta-Analysis.","authors":"Sarah Angelique Shi En Yip, Queena Zhi Xuan Lim, Gwyneth Kong, Zubair Amin, Yvonne Peng Mei Ng","doi":"10.1001/jamanetworkopen.2025.53712","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.53712","url":null,"abstract":"<p><strong>Importance: </strong>Quality of life (QOL) of parents following the birth of a premature infant is substantially affected, necessitating a comprehensive understanding of its determinants to guide effective interventions.</p><p><strong>Objectives: </strong>To systematically assess QOL among parents of premature infants and to identify modifiable factors associated with their well-being.</p><p><strong>Data sources: </strong>PubMed, CINAHL, and Embase were searched from inception to October 5, 2025.</p><p><strong>Study selection: </strong>Cross-sectional studies, longitudinal cohort studies, and randomized clinical trials reporting quantitative QOL data using validated instruments were included.</p><p><strong>Data extraction and synthesis: </strong>The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Meta-analysis was performed using random-effects models. All studies underwent qualitative synthesis and quality appraisal. Data were extracted and quality was assessed by 2 independent reviewers.</p><p><strong>Main outcomes and measures: </strong>Meta-analysis was carried out on studies that used the World Health Organization QOL-Short Form (WHOQOL-BREF; range, 0-100, with higher scores indicating better QOL) and the 12-Item Short Form Health Survey (SF-12; mean score, 50, with higher scores indicating better QOL) to assess the QOL among parents of preterm children. Qualitative analysis was performed to compare QOL of parents following preterm and full-term births, fathers vs mothers, and by degree of prematurity. Modifiable factors associated with QOL were identified by synthesizing evidence from longitudinal cohort studies and randomized clinical trials.</p><p><strong>Results: </strong>A total of 34 studies, with 6617 parents of preterm children and 8295 parents of full-term children, were included. Meta-analysis of WHOQOL-BREF data (10 studies, 1147 parents of preterm children) showed pooled mean domain scores ranged from 63.63 (95% CI, 54.00-73.35) in the environmental domain to 66.68 (95% CI, 59.77-73.60) in the psychological well-being domain. Systematic review found that lower parental QOL was evident during infant hospitalization with improvement over time. Meta-analysis of SF-12 data (5 studies, 3137 parents) revealed pooled mean physical and mental component summary scores of 47.22 (95% CI, 40.06-54.39) and 44.58 (95% CI, 39.01-50.16), respectively. High heterogeneity reflected variability of infant maturity, assessment timing, and sociodemographic factors. Parents of preterm infants reported lower QOL than parents of full-term children in the early postpartum period, but this gap narrowed over time. Mothers reported poorer QOL compared with fathers during the infant's hospitalization, but the gap diminished by 4 to 6 months post partum. Key modifiable factors of QOL were parental psychological well-being, knowledge and empowerment, social and systemic support, and in","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2553712"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.53146
Jennifer S Wang, Benny Johnson, Caitlin C Murphy
Importance: Rates of metastatic colorectal cancer (mCRC) are rising among young adults. Disparities by race and ethnicity and neighborhood-level socioeconomic status (SES) among this population are understudied.
Objective: To examine the association of race and ethnicity and neighborhood-level SES with mortality among a community-based sample of young adults with mCRC.
Design, setting, and participants: This cohort study used a large electronic health record-derived database of young adults with cancer treated at 280 community-based US clinics between 2013 and 2021. Eligible patients were young adults aged 18 to 49 years diagnosed with de novo or recurrent mCRC. Patients were followed up until December 31, 2022. Data were analyzed from February 2024 to November 2025.
Exposures: Race and ethnicity and neighborhood-level SES. Neighborhood-level SES was derived using census block group (2010 Census boundaries) and most recent address in the electronic health record. Five-year estimates from the American Community Survey (2015-2019) were used to compute the Yost Index, a composite measure of 7 variables that capture different aspects of neighborhood-level SES.
Main outcome and measure: All-cause mortality and 1-, 2-, and 3-year survival from diagnosis. Survival was defined from date of de novo or recurrent mCRC diagnosis to date of death or December 31, 2022.
Results: A total of 3115 young adults diagnosed with mCRC (mean [SD] age at diagnosis, 42.4 [5.9] years; 122 Asian [3.9%], 424 Black [13.6%], 395 Hispanic [12.7%], 1874 White [60.2%]; 1651 male [53.0%]). Survival differed significantly by race and ethnicity and neighborhood-level SES. At 3 years after diagnosis, Black patients had worse survival (41%; 95% CI, 36%-46%), while Asian (58%; 95% CI, 48%-66%) and Hispanic (53%; 95% CI, 48%-58%) patients had better survival compared with White patients (47%; 95% CI, 45%-49%). For neighborhood-level SES, 3-year survival was 41% (95% CI, 36%-45%) for patients in the lowest compared with 59% (95% CI, 54%-63%) in the highest quintile. In adjusted analyses, neighborhood-level SES was associated with mortality (Q1 vs Q5: hazard ratio [HR], 1.51; 95% CI, 1.24-1.82), while the HR for Black race and mortality was greater than 1 but not statistically significant (HR, 1.08; 95% CI, 0.90-1.31).
Conclusions: In this cohort study of young adults with mCRC, 3-year survival differed by race and ethnicity and neighborhood-level SES, but only the association between neighborhood-level SES and survival remained statistically significant after adjusting for covariates.
{"title":"Racial, Ethnic, and Socioeconomic Survival Disparities in Early-Onset Metastatic Colorectal Cancer.","authors":"Jennifer S Wang, Benny Johnson, Caitlin C Murphy","doi":"10.1001/jamanetworkopen.2025.53146","DOIUrl":"10.1001/jamanetworkopen.2025.53146","url":null,"abstract":"<p><strong>Importance: </strong>Rates of metastatic colorectal cancer (mCRC) are rising among young adults. Disparities by race and ethnicity and neighborhood-level socioeconomic status (SES) among this population are understudied.</p><p><strong>Objective: </strong>To examine the association of race and ethnicity and neighborhood-level SES with mortality among a community-based sample of young adults with mCRC.</p><p><strong>Design, setting, and participants: </strong>This cohort study used a large electronic health record-derived database of young adults with cancer treated at 280 community-based US clinics between 2013 and 2021. Eligible patients were young adults aged 18 to 49 years diagnosed with de novo or recurrent mCRC. Patients were followed up until December 31, 2022. Data were analyzed from February 2024 to November 2025.</p><p><strong>Exposures: </strong>Race and ethnicity and neighborhood-level SES. Neighborhood-level SES was derived using census block group (2010 Census boundaries) and most recent address in the electronic health record. Five-year estimates from the American Community Survey (2015-2019) were used to compute the Yost Index, a composite measure of 7 variables that capture different aspects of neighborhood-level SES.</p><p><strong>Main outcome and measure: </strong>All-cause mortality and 1-, 2-, and 3-year survival from diagnosis. Survival was defined from date of de novo or recurrent mCRC diagnosis to date of death or December 31, 2022.</p><p><strong>Results: </strong>A total of 3115 young adults diagnosed with mCRC (mean [SD] age at diagnosis, 42.4 [5.9] years; 122 Asian [3.9%], 424 Black [13.6%], 395 Hispanic [12.7%], 1874 White [60.2%]; 1651 male [53.0%]). Survival differed significantly by race and ethnicity and neighborhood-level SES. At 3 years after diagnosis, Black patients had worse survival (41%; 95% CI, 36%-46%), while Asian (58%; 95% CI, 48%-66%) and Hispanic (53%; 95% CI, 48%-58%) patients had better survival compared with White patients (47%; 95% CI, 45%-49%). For neighborhood-level SES, 3-year survival was 41% (95% CI, 36%-45%) for patients in the lowest compared with 59% (95% CI, 54%-63%) in the highest quintile. In adjusted analyses, neighborhood-level SES was associated with mortality (Q1 vs Q5: hazard ratio [HR], 1.51; 95% CI, 1.24-1.82), while the HR for Black race and mortality was greater than 1 but not statistically significant (HR, 1.08; 95% CI, 0.90-1.31).</p><p><strong>Conclusions: </strong>In this cohort study of young adults with mCRC, 3-year survival differed by race and ethnicity and neighborhood-level SES, but only the association between neighborhood-level SES and survival remained statistically significant after adjusting for covariates.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2553146"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.53323
Zicheng Wang, Lei Wang, Xinmeng Zhang, Brandon D Lowery, Lauren Lee Shaffer, You Chen, Quinn S Wells, Charles R Flynn, Brandon Williams, Matthew Spann, Gitanjali Srivastava, Jason M Samuels, Danxia Yu
<p><strong>Importance: </strong>The association of bariatric surgery and newer glucagon-like peptide-1 receptor agonists (GLP-1RAs; semaglutide and tirzepatide) with body composition still lack evidence from clinical settings.</p><p><strong>Objective: </strong>To examine temporal changes in fat-free mass (FFM), fat mass (FM), and FFM to FM ratio after bariatric surgery or GLP-1RA treatment over 24 months.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used electronic health records from Vanderbilt University Medical Center of 1257 patients aged 18 to 65 years who underwent first-time bariatric surgery from November 21, 2017, to July 21, 2022, without GLP-1RA treatment from 1 year before to 2 years after surgery, and 1809 nonsurgical patients who started semaglutide or tirzepatide between November 12, 2018, and December 6, 2023, with 2 or more prescriptions or 5% or more weight loss. All patients had 2 or more bioelectrical impedance analysis measures and no history of end-stage kidney disease or congestive heart failure.</p><p><strong>Exposures: </strong>Bariatric surgery or GLP-1RA (semaglutide or tirzepatide) treatment.</p><p><strong>Main outcomes and measures: </strong>Relative changes in FFM, FM, and FFM to FM ratio over 24 months, controlling for age, sex, race, baseline body mass index (BMI), diabetes history, treatment year, time (restricted cubic splines), and time spline-by-treatment interaction.</p><p><strong>Results: </strong>The study comprised 3066 patients: 1257 in the surgery group (mean [SD] age, 43.4 [10.3] years; mean [SD] baseline BMI, 46.8 [7.1]; 1033 women [82.2%]) and 1809 in the GLP-1RA group (mean [SD] age, 45.4 [11.3] years; mean [SD] baseline BMI, 41.0 [7.9]; 1457 women [80.5%]). Adjusted mean relative FM reductions in the surgery group were 42.4% (95% CI, 41.5%-43.2%) at 6 months, 49.7% (95% CI, 48.8%-50.6%) at 12 months, and 49.7% (95% CI, 47.8%-51.5%) at 24 months; reductions in the GLP-1RA group were 10.3% (95% CI, 9.5%-11.0%) at 6 months, 17.3% (95% CI, 16.5%-18.1%) at 12 months, and 18.0% (95% CI, 16.4%-19.7%) at 12 months. Adjusted mean relative FFM reductions in the surgery group were 7.8% (95% CI, 7.2%-8.4%) at 6 months, 10.6% (95% CI, 10.0%-11.2%) at 12 months, and 11.7% (95% CI, 10.4%-12.9%) at 24 months; reductions in the GLP-1RA group were 1.8% (95% CI, 1.3%-2.4%) at 6 months, 3.0% (95% CI, 2.4%-3.5%) at 12 months, and 3.3% (95% CI, 2.1%-4.4%) at 24 months. FFM to FM ratios increased significantly in both groups, with surgical patients maintaining a higher ratio throughout: the FFM to FM ratios in the surgery group were 1.8 (95% CI, 1.8-1.8) at 6 months, 2.1 (95% CI, 2.1-2.1) at 12 months, and 2.0 (95% CI, 2.0-2.1) at 24 months; the FFM to FM ratios in the GLP-1RA group were 1.4 (95% CI, 1.4-1.4) at 6 months, 1.5 (95% CI, 1.4-1.5) at 12 months, and 1.5 (95% CI, 1.5-1.6) at 24 months. Similar trends were observed in stratified analyses by sex, race, baseline BMI, bas
{"title":"Body Composition Changes After Bariatric Surgery or Treatment With GLP-1 Receptor Agonists.","authors":"Zicheng Wang, Lei Wang, Xinmeng Zhang, Brandon D Lowery, Lauren Lee Shaffer, You Chen, Quinn S Wells, Charles R Flynn, Brandon Williams, Matthew Spann, Gitanjali Srivastava, Jason M Samuels, Danxia Yu","doi":"10.1001/jamanetworkopen.2025.53323","DOIUrl":"10.1001/jamanetworkopen.2025.53323","url":null,"abstract":"<p><strong>Importance: </strong>The association of bariatric surgery and newer glucagon-like peptide-1 receptor agonists (GLP-1RAs; semaglutide and tirzepatide) with body composition still lack evidence from clinical settings.</p><p><strong>Objective: </strong>To examine temporal changes in fat-free mass (FFM), fat mass (FM), and FFM to FM ratio after bariatric surgery or GLP-1RA treatment over 24 months.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used electronic health records from Vanderbilt University Medical Center of 1257 patients aged 18 to 65 years who underwent first-time bariatric surgery from November 21, 2017, to July 21, 2022, without GLP-1RA treatment from 1 year before to 2 years after surgery, and 1809 nonsurgical patients who started semaglutide or tirzepatide between November 12, 2018, and December 6, 2023, with 2 or more prescriptions or 5% or more weight loss. All patients had 2 or more bioelectrical impedance analysis measures and no history of end-stage kidney disease or congestive heart failure.</p><p><strong>Exposures: </strong>Bariatric surgery or GLP-1RA (semaglutide or tirzepatide) treatment.</p><p><strong>Main outcomes and measures: </strong>Relative changes in FFM, FM, and FFM to FM ratio over 24 months, controlling for age, sex, race, baseline body mass index (BMI), diabetes history, treatment year, time (restricted cubic splines), and time spline-by-treatment interaction.</p><p><strong>Results: </strong>The study comprised 3066 patients: 1257 in the surgery group (mean [SD] age, 43.4 [10.3] years; mean [SD] baseline BMI, 46.8 [7.1]; 1033 women [82.2%]) and 1809 in the GLP-1RA group (mean [SD] age, 45.4 [11.3] years; mean [SD] baseline BMI, 41.0 [7.9]; 1457 women [80.5%]). Adjusted mean relative FM reductions in the surgery group were 42.4% (95% CI, 41.5%-43.2%) at 6 months, 49.7% (95% CI, 48.8%-50.6%) at 12 months, and 49.7% (95% CI, 47.8%-51.5%) at 24 months; reductions in the GLP-1RA group were 10.3% (95% CI, 9.5%-11.0%) at 6 months, 17.3% (95% CI, 16.5%-18.1%) at 12 months, and 18.0% (95% CI, 16.4%-19.7%) at 12 months. Adjusted mean relative FFM reductions in the surgery group were 7.8% (95% CI, 7.2%-8.4%) at 6 months, 10.6% (95% CI, 10.0%-11.2%) at 12 months, and 11.7% (95% CI, 10.4%-12.9%) at 24 months; reductions in the GLP-1RA group were 1.8% (95% CI, 1.3%-2.4%) at 6 months, 3.0% (95% CI, 2.4%-3.5%) at 12 months, and 3.3% (95% CI, 2.1%-4.4%) at 24 months. FFM to FM ratios increased significantly in both groups, with surgical patients maintaining a higher ratio throughout: the FFM to FM ratios in the surgery group were 1.8 (95% CI, 1.8-1.8) at 6 months, 2.1 (95% CI, 2.1-2.1) at 12 months, and 2.0 (95% CI, 2.0-2.1) at 24 months; the FFM to FM ratios in the GLP-1RA group were 1.4 (95% CI, 1.4-1.4) at 6 months, 1.5 (95% CI, 1.4-1.5) at 12 months, and 1.5 (95% CI, 1.5-1.6) at 24 months. Similar trends were observed in stratified analyses by sex, race, baseline BMI, bas","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2553323"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12789952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.51543
Anna C Beck, Lee G Wilke, Ingrid M Lizarraga
{"title":"Risk Counseling Tools for Contralateral Breast Cancer Risk After Genetic Testing.","authors":"Anna C Beck, Lee G Wilke, Ingrid M Lizarraga","doi":"10.1001/jamanetworkopen.2025.51543","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.51543","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2551543"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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