JAMA Internal Medicine最新文献

英文中文

Missed Posterior Myocardial Infarction Leading to Free Wall Rupture. 遗漏后壁心肌梗死导致游离壁破裂。

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-02 DOI: 10.1001/jamainternmed.2025.7644

Khoa Quy, Dao V Nguyen, Huy Q Dang

引用次数: 0

The Future of Nutrition Interventions in Medicaid. 医疗补助中营养干预的未来。

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-02 DOI: 10.1001/jamainternmed.2025.7194

Kurt Hager, Seth A Berkowitz

引用次数: 0

Oral Semaglutide and Heart Failure Outcomes in Persons With Type 2 Diabetes: A Secondary Analysis of the SOUL Randomized Clinical Trial. 口服西马鲁肽和2型糖尿病患者心力衰竭结局：SOUL随机临床试验的二次分析

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-02 DOI: 10.1001/jamainternmed.2025.7774

Rodica Pop-Busui, Søren Rasmussen, John E Deanfield, John B Buse, Nikolaus Marx, Sharon L Mulvagh, Silvio E Inzucchi, Johannes F E Mann, Scott S Emerson, Neil R Poulter, Mads D M Engelmann, G Kees Hovingh, Katrine Bayer Tanggaard, Andreas L Birkenfeld, Kim A Connelly, Martin Haluzik, Matthew A Cavender, Monika Kellerer, Pardeep S Jhund, Søren Gregersen, Olav Wendelboe Nielsen, Carolyn S P Lam, Darren K McGuire

Importance: Heart failure (HF) is a common complication of type 2 diabetes (T2D). Oral semaglutide reduced the risk of major adverse cardiovascular (CV) events (MACE; comprising CV death, nonfatal myocardial infarction, or nonfatal stroke) in people with T2D in the SOUL trial, but the impact on HF outcomes in these participants is unknown.Objective: To evaluate the effect of oral semaglutide on HF events, MACE, and safety among participants with or without HF at baseline.Design, setting, and participants: This is a secondary analysis of the double-blind, placebo-controlled, event-driven, phase 3b SOUL randomized clinical trial, which was conducted at 444 centers in 33 countries. Participants were enrolled from June 17, 2019, to March 24, 2021, and had T2D and atherosclerotic CV disease and/or chronic kidney disease, stratified according to the presence or absence of HF history at baseline. Data were analyzed from December 2024 to August 2025.Intervention: Once-daily oral semaglutide or placebo in addition to standard of care.Main outcomes and measures: Prespecified composite HF outcome (time to first occurrence of HF hospitalization, urgent HF visit, or CV death).Results: Overall, 9650 participants (median [IQR] age, 66.0 [61.0-72.0] years; 2790 [28.9%] female) were randomized, with a mean (SD) follow-up of 47.5 (10.9) months. Of these participants, 2229 (23.1%) had HF history (991 [10.3%] with preserved ejection fraction, 592 [6.1%] with reduced ejection fraction, and 646 [6.7%] with unknown subtype). For participants with HF at baseline, the hazard ratio (HR) for risk of the composite HF outcome with oral semaglutide vs placebo was 0.78 (95% CI, 0.63-0.96) and was 1.01 (95% CI, 0.84-1.20) in those without HF at baseline (P for interaction = .06). Among participants with HF, the HR was 0.59 (95% CI, 0.39-0.86) in those with preserved ejection fraction and 0.98 (95% CI, 0.70-1.38) in those with reduced ejection fraction. There was no heterogeneity in the risk reduction of MACE with oral semaglutide in participants with HF history (HR, 0.83; 95% CI, 0.68-1.01) or without HF history (HR, 0.86; 95% CI, 0.75-0.98) (P for interaction = .77). Serious adverse event occurrence among participants with HF was similar with oral semaglutide (594 [53.8%]) and placebo (642 [57.1%]).Conclusions and relevance: In this secondary analysis of the SOUL randomized clinical trial, among individuals with T2D, atherosclerotic CV disease, and/or chronic kidney disease, a reduction of HF events was observed with use of oral semaglutide compared with placebo in those with a history of HF, without increasing the risk of serious adverse events. These data support the potential benefit of oral semaglutide in reducing HF events in people with T2D and HF.Trial registration: ClinicalTrials.gov

重要性：心力衰竭（HF）是2型糖尿病（T2D）的常见并发症。在SOUL试验中，口服西马鲁肽降低了T2D患者主要心血管不良事件（MACE，包括心血管死亡、非致死性心肌梗死或非致死性卒中）的风险，但对这些参与者的HF结局的影响尚不清楚。目的：评估口服西马鲁肽对HF事件、MACE和基线时HF患者或非HF患者安全性的影响。设计、环境和参与者：这是对双盲、安慰剂对照、事件驱动、3b期SOUL随机临床试验的二次分析，该试验在33个国家的444个中心进行。参与者于2019年6月17日至2021年3月24日入组，并患有T2D和动脉粥样硬化性CV疾病和/或慢性肾脏疾病，根据基线时是否存在HF病史进行分层。数据分析时间为2024年12月至2025年8月。干预措施：每日一次口服西马鲁肽或安慰剂，外加标准治疗。主要结局和指标：预先设定的HF综合结局（首次发生HF住院的时间、HF紧急就诊或CV死亡）。结果：总体而言，9650名参与者（中位[IQR]年龄66.0[61.0-72.0]岁；2790名[28.9%]女性）被随机分组，平均（SD）随访时间为47.5（10.9）个月。在这些参与者中，2229人（23.1%）有HF病史（射血分数保存的991人（10.3%），射血分数降低的592人（6.1%），未知亚型的646人（6.7%））。对于基线时患有HF的参与者，口服西马鲁肽与安慰剂复合HF结局风险的危险比（HR）为0.78 (95% CI, 0.63-0.96)，而基线时没有HF的参与者的危险比（HR）为1.01 (95% CI, 0.84-1.20)（相互作用P = 0.06）。在HF患者中，射血分数保持者的HR为0.59 (95% CI, 0.39-0.86)，射血分数降低者的HR为0.98 （95% CI, 0.70-1.38）。在有HF病史（HR, 0.83; 95% CI, 0.68-1.01）或没有HF病史（HR, 0.86; 95% CI, 0.75-0.98）的受试者中，口服西马鲁肽降低MACE的风险没有异质性（相互作用P = 0.77）。HF患者的严重不良事件发生率与口服西马鲁肽（594例[53.8%]）和安慰剂（642例[57.1%]）相似。结论和相关性：在SOUL随机临床试验的二级分析中，在患有T2D、动脉粥样硬化性CV疾病和/或慢性肾脏疾病的个体中，与有HF病史的患者相比，使用口服西马鲁肽可减少HF事件，且未增加严重不良事件的风险。这些数据支持口服西马鲁肽在减少T2D和HF患者HF事件方面的潜在益处。试验注册：ClinicalTrials.gov标识符：NCT03914326。

{"title":"Oral Semaglutide and Heart Failure Outcomes in Persons With Type 2 Diabetes: A Secondary Analysis of the SOUL Randomized Clinical Trial.","authors":"Rodica Pop-Busui, Søren Rasmussen, John E Deanfield, John B Buse, Nikolaus Marx, Sharon L Mulvagh, Silvio E Inzucchi, Johannes F E Mann, Scott S Emerson, Neil R Poulter, Mads D M Engelmann, G Kees Hovingh, Katrine Bayer Tanggaard, Andreas L Birkenfeld, Kim A Connelly, Martin Haluzik, Matthew A Cavender, Monika Kellerer, Pardeep S Jhund, Søren Gregersen, Olav Wendelboe Nielsen, Carolyn S P Lam, Darren K McGuire","doi":"10.1001/jamainternmed.2025.7774","DOIUrl":"10.1001/jamainternmed.2025.7774","url":null,"abstract":"Importance: Heart failure (HF) is a common complication of type 2 diabetes (T2D). Oral semaglutide reduced the risk of major adverse cardiovascular (CV) events (MACE; comprising CV death, nonfatal myocardial infarction, or nonfatal stroke) in people with T2D in the SOUL trial, but the impact on HF outcomes in these participants is unknown.Objective: To evaluate the effect of oral semaglutide on HF events, MACE, and safety among participants with or without HF at baseline.Design, setting, and participants: This is a secondary analysis of the double-blind, placebo-controlled, event-driven, phase 3b SOUL randomized clinical trial, which was conducted at 444 centers in 33 countries. Participants were enrolled from June 17, 2019, to March 24, 2021, and had T2D and atherosclerotic CV disease and/or chronic kidney disease, stratified according to the presence or absence of HF history at baseline. Data were analyzed from December 2024 to August 2025.Intervention: Once-daily oral semaglutide or placebo in addition to standard of care.Main outcomes and measures: Prespecified composite HF outcome (time to first occurrence of HF hospitalization, urgent HF visit, or CV death).Results: Overall, 9650 participants (median [IQR] age, 66.0 [61.0-72.0] years; 2790 [28.9%] female) were randomized, with a mean (SD) follow-up of 47.5 (10.9) months. Of these participants, 2229 (23.1%) had HF history (991 [10.3%] with preserved ejection fraction, 592 [6.1%] with reduced ejection fraction, and 646 [6.7%] with unknown subtype). For participants with HF at baseline, the hazard ratio (HR) for risk of the composite HF outcome with oral semaglutide vs placebo was 0.78 (95% CI, 0.63-0.96) and was 1.01 (95% CI, 0.84-1.20) in those without HF at baseline (P for interaction = .06). Among participants with HF, the HR was 0.59 (95% CI, 0.39-0.86) in those with preserved ejection fraction and 0.98 (95% CI, 0.70-1.38) in those with reduced ejection fraction. There was no heterogeneity in the risk reduction of MACE with oral semaglutide in participants with HF history (HR, 0.83; 95% CI, 0.68-1.01) or without HF history (HR, 0.86; 95% CI, 0.75-0.98) (P for interaction = .77). Serious adverse event occurrence among participants with HF was similar with oral semaglutide (594 [53.8%]) and placebo (642 [57.1%]).Conclusions and relevance: In this secondary analysis of the SOUL randomized clinical trial, among individuals with T2D, atherosclerotic CV disease, and/or chronic kidney disease, a reduction of HF events was observed with use of oral semaglutide compared with placebo in those with a history of HF, without increasing the risk of serious adverse events. These data support the potential benefit of oral semaglutide in reducing HF events in people with T2D and HF.Trial registration: ClinicalTrials.gov ","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":23.3,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105492","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}

引用次数: 0

Promoting Health Equity for People With Intellectual and Developmental Disabilities Through Research. 通过研究促进智力和发育障碍者的健康平等。

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-02 DOI: 10.1001/jamainternmed.2025.7419

Dimitri A Christakis, Douglas S Diekema

引用次数: 0

Hypertensive Disorders of Pregnancy Subtypes and Long-Term Cardiovascular Risk. 妊娠期高血压疾病亚型与长期心血管风险

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-02 DOI: 10.1001/jamainternmed.2025.7802

Soongu Kwak, Chan Soon Park, Yebin Park, Tae-Min Rhee, Heesun Lee, Hyung-Kwan Kim, Yong-Jin Kim, Kyungdo Han, Jun-Bean Park

Importance: Hypertensive disorders of pregnancy (HDPs) are associated with an increased long-term risk of cardiovascular disease, but the risks across different HDP subtypes, particularly those other than preeclampsia, remain unclear.

Objective: To examine whether the risk and distribution of specific cardiovascular outcomes differ across HDP subtypes.

Design, setting, and participants: This nationwide cohort study retrospectively analyzed women with deliveries in South Korea from 2010 to 2018 using the National Health Insurance Service database. HDPs were classified into 5 subtypes: chronic hypertension, gestational hypertension, superimposed preeclampsia, preeclampsia/eclampsia, and unspecified hypertension. Events were verified through December 2022. Data were analyzed from June 1 to October 31, 2025.

Exposures: HDPs and their subtypes.

Main outcomes and measures: The primary outcome was a composite of cardiovascular events, including cardiovascular death, heart failure, myocardial infarction, stroke, and atrial fibrillation. Adjusted hazard ratios (AHRs) were estimated using Cox models accounting for age, cardiovascular comorbidities, demographic, lifestyle, and pregnancy-related factors.

Results: Among 570 843 women (mean [SD] age, 32.7 [4.0] years), 22 876 (4.0%) had HDPs. HDPs were associated with a higher incidence of cardiovascular events compared with women without HDPs (AHR, 1.62; 95% CI, 1.49-1.76; P < .001). The absolute risk increase was approximately 2.10 additional cardiovascular events per 1000 person-years over a median follow-up of 6.5 years (IQR, 4.7-8.7 years; incidence rate, 4.39 vs 2.29 per 1000 person-years). Among those with HDPs, 34.8% had gestational hypertension, 32.4% had preeclampsia or eclampsia, 17.7% had unspecified hypertension, 12.3% had chronic hypertension, and 2.8% had superimposed preeclampsia. All subtypes were independently associated with higher cardiovascular risk, with the highest risk observed in superimposed preeclampsia compared with women without HDPs (AHR, 2.93; 95% CI, 2.15-3.99; P < .001). All subtypes were associated with increased risks of heart failure and stroke, and most subtypes were associated with higher cardiovascular mortality. Unspecified hypertension was associated with myocardial infarction, and chronic hypertension and unspecified hypertension were associated with atrial fibrillation.

Conclusions and relevance: In this cohort study, all HDP subtypes were associated with modest increases in long-term cardiovascular risk, except superimposed preeclampsia, which was associated with a markedly higher risk. These findings suggest that women with superimposed preeclampsia may benefit from closer postpartum cardiovascular surveillance.

重要性：妊娠高血压疾病（HDP）与心血管疾病的长期风险增加有关，但不同HDP亚型的风险，特别是除先兆子痫外的风险尚不清楚。目的：探讨不同HDP亚型患者特定心血管结局的风险和分布是否存在差异。设计、环境和参与者：这项全国性队列研究使用国民健康保险服务数据库，回顾性分析了2010年至2018年韩国分娩的妇女。hdp分为5个亚型：慢性高血压、妊娠期高血压、叠加性子痫前期、子痫前期/子痫和未明确的高血压。事件的核实一直持续到2022年12月。数据分析时间为2025年6月1日至10月31日。暴露：hdp及其亚型。主要结局和指标：主要结局是心血管事件的综合，包括心血管死亡、心力衰竭、心肌梗死、中风和心房颤动。校正风险比（AHRs）使用Cox模型估计，考虑年龄、心血管合并症、人口统计学、生活方式和妊娠相关因素。结果：570 843名女性（平均[SD]年龄32.7[4.0]岁）中，22 876名（4.0%）患有HDPs。结论和相关性：在该队列研究中，所有HDP亚型均与长期心血管风险适度增加相关，除了叠加性先兆子痫，其风险明显升高。这些发现表明，合并先兆子痫的妇女可能受益于产后更密切的心血管监测。

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引用次数: 0

An Unexpected Cause of Hypotension. 低血压的意外原因。

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1001/jamainternmed.2025.6324

Jacob R Heath, Amanda Chang, Marie Finkbeiner

引用次数: 0

Risk of Burdensome Health Care Spending Over Time in the US. 随着时间的推移，美国繁重的医疗保健支出的风险。

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1001/jamainternmed.2025.6948

Adam Gaffney, Danny McCormick, Samuel L Dickman, David Bor, Lenore Azaroff, David U Himmelstein, Steffie Woolhandler

Importance: Cross-sectional studies indicate that out-of-pocket (OOP) health care costs strain household finances, but few studies have examined the risk of incurring burdensome health care spending longitudinally among individuals in the US.

Objective: To assess burdensome OOP health care costs (and care foregone due to cost) over a 4-year period.

Design, setting, and participants: In this cohort study, data were analyzed on respondents to the 4-year longitudinal Medical Expenditure Panel Surveys (MEPS), a nationally representative household survey of the US noninstitutionalized population conducted from 2018 to 2022. Analyses were performed from November 2024 to October 2025.

Main outcomes and measures: Primary outcomes included 4 cost-related outcomes: cost burden, defined as individual annual OOP medical spending greater than 10% of family income (>5% for low-income individuals); catastrophic cost burden (CCB) defined as OOP spending greater than 40% of postsubsistence income; foregone care due to cost; and family-level cost burden. Risk was assessed using time-to-event analyses, overall and among subgroups, eg, baseline chronic disease, hospitalization, and uninsurance, and death during the study period.

Results: Among 12 645 MEPS respondents, 74.6% (95% CI, 73.4%-75.8%) were aged 18 years or older and 50.6% (95% CI, 49.7%-51.6%) were female individuals (weighted); among adults, 50.3% (95% CI, 48.6%-52.0%) had a chronic disease, 7.9% (95% CI, 7.2%-8.7%) were hospitalized, and 2.3% (95% CI, 2.0%-2.6%) died. During year 1, 6.5% of adults experienced cost burdens (and 3.5% CCB); 17.4% (and 9.9% CCB) experienced these outcomes (respectively) at least once over 4 years. Overall, 24.7% of US individuals lived in families experiencing cost burdens over 4 years, and 11.2% lived in families experiencing CCBs. Overall, 26.7% of adults experienced either foregone care due to cost or cost burden over 4 years. Lower income, having no insurance, hospitalizations, and chronic disease were each associated with higher cost burden. Overall, 53.2% of decedents experienced cost burdens in 1 to 4 years before death.

Conclusions and relevance: This cohort study found that the US health care system imposes cost burdens on a larger share of the population than suggested by cross-sectional analyses, and most individuals in the US will experience such burdens during their lifetimes. Policies that reduce OOP costs might improve the well-being of individuals in the US.

重要性：横断面研究表明，自费（OOP）卫生保健费用紧张家庭财政，但很少有研究已经检查了在美国个人中产生负担的卫生保健支出的风险。目的：评估4年期间面向对象的繁重医疗保健费用（以及因费用而放弃的医疗费用）。设计、环境和参与者：在本队列研究中，分析了4年纵向医疗支出小组调查（MEPS）的受访者的数据，MEPS是一项2018年至2022年对美国非机构人口进行的全国代表性家庭调查。分析时间为2024年11月至2025年10月。主要结局和指标：主要结局包括4个与成本相关的结局：成本负担，定义为个人年度OOP医疗支出大于家庭收入的10%（低收入个人为5%）；灾难性成本负担（CCB）定义为OOP支出超过生存后收入的40%；因费用而放弃的照顾；以及家庭层面的成本负担。使用总体和亚组间的事件时间分析来评估风险，例如，研究期间基线慢性疾病、住院、无保险和死亡。结果：在12名 645名MEPS受访者中，74.6% （95% CI, 73.4%-75.8%）年龄在18岁或以上，50.6% （95% CI, 49.7%-51.6%）为女性个体（加权）；在成人中，50.3% （95% CI, 48.6%-52.0%）患有慢性疾病，7.9% （95% CI, 7.2%-8.7%）住院，2.3% （95% CI, 2.0%-2.6%）死亡。在第一年，6.5%的成年人经历了成本负担（3.5%的CCB）；17.4%的CCB（和9.9%的CCB）在4年内分别至少经历过一次这些结果。总体而言，24.7%的美国人生活在经历4年以上成本负担的家庭中，11.2%的人生活在经历CCBs的家庭中。总体而言，26.7%的成年人在4年内因费用或费用负担而放弃护理。低收入、无保险、住院和慢性疾病均与较高的成本负担相关。总体而言，53.2%的死者在死亡前1至4年内经历了费用负担。结论和相关性：该队列研究发现，美国医疗保健系统给人口带来的成本负担比横断面分析所显示的要大，而且大多数美国人在其一生中都会经历这种负担。降低面向对象成本的政策可能会改善美国个人的福祉。

{"title":"Risk of Burdensome Health Care Spending Over Time in the US.","authors":"Adam Gaffney, Danny McCormick, Samuel L Dickman, David Bor, Lenore Azaroff, David U Himmelstein, Steffie Woolhandler","doi":"10.1001/jamainternmed.2025.6948","DOIUrl":"10.1001/jamainternmed.2025.6948","url":null,"abstract":"Importance: Cross-sectional studies indicate that out-of-pocket (OOP) health care costs strain household finances, but few studies have examined the risk of incurring burdensome health care spending longitudinally among individuals in the US.Objective: To assess burdensome OOP health care costs (and care foregone due to cost) over a 4-year period.Design, setting, and participants: In this cohort study, data were analyzed on respondents to the 4-year longitudinal Medical Expenditure Panel Surveys (MEPS), a nationally representative household survey of the US noninstitutionalized population conducted from 2018 to 2022. Analyses were performed from November 2024 to October 2025.Main outcomes and measures: Primary outcomes included 4 cost-related outcomes: cost burden, defined as individual annual OOP medical spending greater than 10% of family income (>5% for low-income individuals); catastrophic cost burden (CCB) defined as OOP spending greater than 40% of postsubsistence income; foregone care due to cost; and family-level cost burden. Risk was assessed using time-to-event analyses, overall and among subgroups, eg, baseline chronic disease, hospitalization, and uninsurance, and death during the study period.Results: Among 12 645 MEPS respondents, 74.6% (95% CI, 73.4%-75.8%) were aged 18 years or older and 50.6% (95% CI, 49.7%-51.6%) were female individuals (weighted); among adults, 50.3% (95% CI, 48.6%-52.0%) had a chronic disease, 7.9% (95% CI, 7.2%-8.7%) were hospitalized, and 2.3% (95% CI, 2.0%-2.6%) died. During year 1, 6.5% of adults experienced cost burdens (and 3.5% CCB); 17.4% (and 9.9% CCB) experienced these outcomes (respectively) at least once over 4 years. Overall, 24.7% of US individuals lived in families experiencing cost burdens over 4 years, and 11.2% lived in families experiencing CCBs. Overall, 26.7% of adults experienced either foregone care due to cost or cost burden over 4 years. Lower income, having no insurance, hospitalizations, and chronic disease were each associated with higher cost burden. Overall, 53.2% of decedents experienced cost burdens in 1 to 4 years before death.Conclusions and relevance: This cohort study found that the US health care system imposes cost burdens on a larger share of the population than suggested by cross-sectional analyses, and most individuals in the US will experience such burdens during their lifetimes. Policies that reduce OOP costs might improve the well-being of individuals in the US.","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"203-213"},"PeriodicalIF":23.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804581","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}

引用次数: 0

Cardiometabolic Parameter Change by Weight Regain on Tirzepatide Withdrawal in Adults With Obesity: A Post Hoc Analysis of the SURMOUNT-4 Trial. 成人肥胖患者停用替西帕肽后体重恢复对心脏代谢参数的影响：一项对SURMOUNT-4试验的事后分析

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1001/jamainternmed.2025.6112

Deborah B Horn, Bruno Linetzky, Melanie J Davies, Luke J Laffin, Hui Wang, Madhumita A Murphy, Sarah Zimner-Rapuch, Eva Lau, Avigdor D Arad, Clare J Lee

Importance: In the SURMOUNT-4 trial, most adults with obesity who had tirzepatide withdrawn following a 36-week treatment regained weight. The association between the degree of weight regain and cardiometabolic parameters after tirzepatide withdrawal is unknown.Objective: To assess changes in cardiometabolic parameters by degree of weight regain after withdrawal of tirzepatide.Design, setting, and participants: This post hoc analysis of the SURMOUNT-4 trial included tirzepatide-treated participants with 10% or greater weight reduction at week 36 initially randomized to placebo. Data were collected from March 2021 to May 2023, and data were analyzed from February 2024 to March 2025.Interventions: After 36 weeks of tirzepatide treatment (maximum tolerated dose of 10 mg or 15 mg), participants were randomized 1:1 to continue tirzepatide or to switch to placebo for 52 weeks (week 36 to 88).Main outcomes and measures: Changes from week 36 to week 88 in cardiometabolic parameters on tirzepatide withdrawal were assessed by the degree of weight regain at week 88 as a percentage of weight lost while receiving tirzepatide from week 0 to 36: less than 25%, 25% to less than 50%, 50% to less than 75%, and 75% or more.Results: Of 308 included participants, 219 (71.1%) were female, 89 (28.9%) were male, and the mean (SD) age was 47.1 (12.2) years. There were 54 participants in the less than 25% weight regain group, 77 in the 25% to less than 50% group, 103 in the 50% to less than 75% group, and 74 in the 75% or more group. Baseline demographic and clinical characteristics were similar across categories. During the initial 36 weeks of tirzepatide treatment, participants' weight decreased and cardiometabolic parameters improved. After withdrawal of tirzepatide, from week 36 to week 88, the mean change in waist circumference increased by weight regain category (<25% weight regain, 0.8 cm; 95% CI, -1.0 to 2.6; 25% to <50%, 5.4 cm; 95% CI, 4.0-6.8; 50% to <75%, 10.1 cm; 95% CI, 8.9-11.3; ≥75%, 14.7 cm; 95% CI, 12.7-16.7; P < .001), as did systolic blood pressure (6.8 mm Hg [95% CI, 3.9-9.7], 7.3 mm Hg [95% CI, 4.8-9.8], 9.6 mm Hg [95% CI, 7.1-12.1], and 10.4 mm Hg [95% CI, 8.0-12.8], respectively; P = .002), non-high-density lipoprotein cholesterol (-0.4% [95% CI, -7.3 to 6.5], 1.6% [95% CI, -2.3 to 5.5], 8.4% [95% CI, 3.9-12.9], and 10.8% [95% CI, 5.3-16.3], respectively), hemoglobin A1c (0.14% [95% CI, 0.06-0.22], 0.15% [95% CI, 0.09-0.21], 0.27% [95% CI, 0.21-0.33], and 0.35% [95% CI, 0.29-0.41], respectively; P < .001), and fasting insulin (-4.0% [95% CI, -20.7 to 12.7], 15.4% [95% CI, 2.3-28.5], 46.2% [95% CI, 29.5-62.9], and 26.3% [95% CI, 9.6-43.0], respectively). Changes at week 88 in waist circumference, non-high-density lipoprotein cholesterol, and fasting insulin in those with less than 25% weight regain were not sign

重要性：在SURMOUNT-4试验中，大多数在36周治疗后停用替西肽的肥胖成人体重恢复。替西肽停药后体重恢复程度与心脏代谢参数之间的关系尚不清楚。目的：评价替西帕肽停药后体重回升程度对心脏代谢参数的影响。设计、环境和参与者：这项对SURMOUNT-4试验的事后分析包括替西肽治疗的参与者，在第36周体重减轻10%或更多，最初随机分配到安慰剂组。数据收集时间为2021年3月至2023年5月，数据分析时间为2024年2月至2025年3月。干预措施：在替西帕肽治疗36周后（最大耐受剂量为10mg或15mg），参与者按1:1的比例随机分配，继续使用替西帕肽或改用安慰剂52周（第36至88周）。主要结局和指标：从第36周到第88周，替西帕肽停药后心脏代谢参数的变化通过第88周体重恢复程度作为体重减轻的百分比进行评估：小于25%，25%至小于50%，50%至小于75%，75%或更高。结果：308名纳入的参与者中，219名（71.1%）为女性，89名（28.9%）为男性，平均（SD）年龄为47.1（12.2）岁。体重恢复不足25%组有54人，25%至50%以下组有77人，50%至75%以下组有103人，75%及以上组有74人。不同类别的基线人口学和临床特征相似。在替西肽治疗的最初36周，参与者的体重下降，心脏代谢参数得到改善。停用替西肽后，从第36周到第88周，腰围的平均变化随体重增加而增加(结论及相关性：在这项对SURMOUNT-4试验的事后分析中，在接受36周替西帕肽治疗后体重减轻的肥胖参与者中，与维持体重减轻的参与者相比，停用替西帕肽导致大多数参与者在1年内体重恢复25%或更高，并且与初始心脏代谢参数改善的逆转相关。这些发现强调了持续治疗肥胖的重要性。试验注册：ClinicalTrials.gov标识符：NCT04660643。

{"title":"Cardiometabolic Parameter Change by Weight Regain on Tirzepatide Withdrawal in Adults With Obesity: A Post Hoc Analysis of the SURMOUNT-4 Trial.","authors":"Deborah B Horn, Bruno Linetzky, Melanie J Davies, Luke J Laffin, Hui Wang, Madhumita A Murphy, Sarah Zimner-Rapuch, Eva Lau, Avigdor D Arad, Clare J Lee","doi":"10.1001/jamainternmed.2025.6112","DOIUrl":"10.1001/jamainternmed.2025.6112","url":null,"abstract":"Importance: In the SURMOUNT-4 trial, most adults with obesity who had tirzepatide withdrawn following a 36-week treatment regained weight. The association between the degree of weight regain and cardiometabolic parameters after tirzepatide withdrawal is unknown.Objective: To assess changes in cardiometabolic parameters by degree of weight regain after withdrawal of tirzepatide.Design, setting, and participants: This post hoc analysis of the SURMOUNT-4 trial included tirzepatide-treated participants with 10% or greater weight reduction at week 36 initially randomized to placebo. Data were collected from March 2021 to May 2023, and data were analyzed from February 2024 to March 2025.Interventions: After 36 weeks of tirzepatide treatment (maximum tolerated dose of 10 mg or 15 mg), participants were randomized 1:1 to continue tirzepatide or to switch to placebo for 52 weeks (week 36 to 88).Main outcomes and measures: Changes from week 36 to week 88 in cardiometabolic parameters on tirzepatide withdrawal were assessed by the degree of weight regain at week 88 as a percentage of weight lost while receiving tirzepatide from week 0 to 36: less than 25%, 25% to less than 50%, 50% to less than 75%, and 75% or more.Results: Of 308 included participants, 219 (71.1%) were female, 89 (28.9%) were male, and the mean (SD) age was 47.1 (12.2) years. There were 54 participants in the less than 25% weight regain group, 77 in the 25% to less than 50% group, 103 in the 50% to less than 75% group, and 74 in the 75% or more group. Baseline demographic and clinical characteristics were similar across categories. During the initial 36 weeks of tirzepatide treatment, participants' weight decreased and cardiometabolic parameters improved. After withdrawal of tirzepatide, from week 36 to week 88, the mean change in waist circumference increased by weight regain category (<25% weight regain, 0.8 cm; 95% CI, -1.0 to 2.6; 25% to <50%, 5.4 cm; 95% CI, 4.0-6.8; 50% to <75%, 10.1 cm; 95% CI, 8.9-11.3; ≥75%, 14.7 cm; 95% CI, 12.7-16.7; P < .001), as did systolic blood pressure (6.8 mm Hg [95% CI, 3.9-9.7], 7.3 mm Hg [95% CI, 4.8-9.8], 9.6 mm Hg [95% CI, 7.1-12.1], and 10.4 mm Hg [95% CI, 8.0-12.8], respectively; P = .002), non-high-density lipoprotein cholesterol (-0.4% [95% CI, -7.3 to 6.5], 1.6% [95% CI, -2.3 to 5.5], 8.4% [95% CI, 3.9-12.9], and 10.8% [95% CI, 5.3-16.3], respectively), hemoglobin A1c (0.14% [95% CI, 0.06-0.22], 0.15% [95% CI, 0.09-0.21], 0.27% [95% CI, 0.21-0.33], and 0.35% [95% CI, 0.29-0.41], respectively; P < .001), and fasting insulin (-4.0% [95% CI, -20.7 to 12.7], 15.4% [95% CI, 2.3-28.5], 46.2% [95% CI, 29.5-62.9], and 26.3% [95% CI, 9.6-43.0], respectively). Changes at week 88 in waist circumference, non-high-density lipoprotein cholesterol, and fasting insulin in those with less than 25% weight regain were not sign","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"157-167"},"PeriodicalIF":23.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587562","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}

引用次数: 0

Taking the Long View on Health Care-Related Financial Hardship. 从长远的角度看待医疗相关的经济困难。

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1001/jamainternmed.2025.6957

John W Scott

引用次数: 0

Benzodiazepine Use in Pregnancy-Understanding Risks for Informed Decision-Making. 妊娠期使用苯二氮卓类药物——了解知情决策的风险。

IF 23.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine

Pub Date : 2026-02-01 DOI: 10.1001/jamainternmed.2025.6890

Anna Hung, Sharon K Inouye, Ilana Richman

引用次数: 0

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