Journal of the National Medical Association最新文献

{"title":"Narrative privilege: Rethinking the personal statement","authors":"Jessica M. Lewis","doi":"10.1016/j.jnma.2026.04.004","DOIUrl":"10.1016/j.jnma.2026.04.004","url":null,"abstract":"<div><div>This letter critiques the role of the personal statement in medical school admissions, highlighting its susceptibility to privilege, coaching, and the growing use of AI for generation. It argues that narrative components may obscure structural disadvantage and calls for reevaluating their use in favor of more equitable, context-sensitive tools that better reflect applicants’ lived experiences and authentic potential.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 565-566"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucose-6-phosphate dehydrogenase activity and genetic variants in tunisian diabetic populations: A case–control study","authors":"Yessine Amri,&nbsp;Mariem Othmani,&nbsp;Nada Hannachi,&nbsp;Sarra Tombari,&nbsp;Siwar Chelbi,&nbsp;Amira Dridi,&nbsp;Nesrine Zmerli,&nbsp;Sondess Hadj Fredj,&nbsp;Taieb Messaoud,&nbsp;Rym Dabboubi","doi":"10.1016/j.jnma.2026.04.007","DOIUrl":"10.1016/j.jnma.2026.04.007","url":null,"abstract":"<div><div>Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common X-linked enzymopathy, is highly prevalent in North Africa and impairs antioxidant defense by reducing NADPH production. Its relationship with diabetes mellitus (DM) remains unclear<strong>.</strong></div><div>Aims: To assess G6PD enzymatic activity, determine the prevalence of G6PD deficiency, and identify common G6PD gene variants in Tunisian patients with type 1 (T1D) and type 2 diabetes mellitus (T2D).</div><div>Methods: This case–control study included 45 T1D and 46 T2D patients, each matched by age and sex to healthy non-diabetic controls (<em>n</em> = 45 and <em>n</em> = 46, respectively). Complete blood count, reticulocyte count, HbA1c, and G6PD activity were measured. Deficiency was defined as &lt;4U/g Hb in males and &lt;5.84U/g Hb in females. ARMS-PCR screened deficient patients for the African Gd A⁻(202A) and Mediterranean B⁻(563T) variants.</div><div>Results: G6PD activity (mean ± SD) did not differ significantly between T1D patients and controls (9.29 ± 2.18 vs. 9.07 ± 1.77 U/g Hb; <em>p</em> = 0.8523). T2D patients had significantly lower activity (5.90 ± 1.40 vs. 7.23 ± 2.16 U/g Hb; <em>p</em> = 0.0024), with a deficiency prevalence of 18.33 % (95 % CI: 9.52–30.44) versus 9.43 % (95 % CI: 3.13–20.66) in controls (<em>p</em> = 0.032, McNemar's test). G6PD activity showed a significant inverse correlation with fasting blood glucose (beta = -0.0058, SE = 0.0016, <em>p</em> = 0.001) and HbA1c (beta = -0.289, SE = 0.062, <em>p</em> &lt; 0.001) in the T2D group. This suggests that poorer glycemic control is associated with reduced enzymatic antioxidant capacity, particularly when HbA1c exceeds a threshold of 8.4 %. Of 11 deficient patients, four heterozygous T2D females (30.36 %) carried the African GdA⁻ variant; no Mediterranean B⁻ variants were found.</div><div>Conclusion: T2D is associated with reduced G6PD activity and higher deficiency prevalence in Tunisia, especially in poorly controlled patients. The predominance of the African Gd A⁻ variant highlights the need for population-specific screening to prevent oxidative stress–related complications and guide personalized diabetes care.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 673-683"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between health literacy, nutrition literacy, and beliefs and behaviors related to cancer prevention","authors":"Dilşat Baş,&nbsp;Ezgi Sakar Schoinas,&nbsp;Vahibe Uluçay Kestane,&nbsp;Tuğçe Aytulu","doi":"10.1016/j.jnma.2026.04.003","DOIUrl":"10.1016/j.jnma.2026.04.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The study evaluates the relationship between cancer prevention beliefs and health and nutrition literacy, and their impact on healthy eating practices.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 811 voluntary adult participants aged 18 to 65. Data were collected via a five-section questionnaire assessing sociodemographic characteristics, cancer prevention beliefs, Mediterranean Diet Adherence Scale (MEDAS), Turkish Health Literacy Scale-32 (TSOY-32), and Self-Perceived Food Literacy Scale (SPFL). Correlations between participants’ mean scores across the scales were analyzed.</div></div><div><h3>Results</h3><div>The mean age of participants was 27.02 ± 10.14 years. Mean scores were 32.01 ± 10.86 for health literacy, 4.00 ± 1.71 for MEDAS, and 89.94 ± 15.46 for SPFL. Fatalistic beliefs about cancer prevention were held by 71.3% of participants. Adequate health literacy and high adherence to the Mediterranean diet were independent variables that increased fatalistic cancer prevention beliefs (<em>p</em> &lt; 0.05), while being over 30 reduced them. Higher education level, perception of health status, adequate nutrition knowledge, and receiving nutrition information from healthcare professionals or dietitians increased health literacy (<em>p</em> &lt; 0.05). Being married, following a special diet, and higher perceived food literacy increased adherence to the Mediterranean diet (<em>p</em> &lt; 0.05). Female gender, regular exercise, and higher perception of health status increased perceived food literacy (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Improving health literacy, education level, perception of health status, and nutrition knowledge, along with ensuring health information from professionals such as dietitians, is essential for enhancing fatalistic beliefs about cancer prevention.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 651-663"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A lifecycle governance and learning health system framework for trustworthy, generalizable, and sustainable human-ai partnership in clinical practice: Lessons from the asthma-guidance and prediction system (A-GPS)","authors":"Chung-Il Wi,&nbsp;Shauna Overgaard,&nbsp;Momin Malik,&nbsp;Dave Watson,&nbsp;Deepak Sharma,&nbsp;Jennifer Le-Rademacher,&nbsp;Dan Kelleher,&nbsp;Lu Zheng,&nbsp;Joshua Ohde,&nbsp;Brian Lynch,&nbsp;Ashwani Khurana,&nbsp;Sunghwan Sohn,&nbsp;Mahmoud M. AlJuhani,&nbsp;Chris Carpenter,&nbsp;Manuel Arteta,&nbsp;Jason Greenwood,&nbsp;Martha Hartz,&nbsp;Randy Foss,&nbsp;Elif Polat,&nbsp;Imad Absah,&nbsp;Young J․ Juhn","doi":"10.1016/j.jnma.2026.04.001","DOIUrl":"10.1016/j.jnma.2026.04.001","url":null,"abstract":"&lt;div&gt;&lt;div&gt;The integration of artificial intelligence (AI) into clinical decision support (CDS) holds promise for proactive, personalized, and precision care. However, current understanding of how to establish trustworthy human-AI partnerships is in its infancy, despite its critical importance for implementing AI in healthcare. We present the Asthma-Guidance and Prediction System (A-GPS) as a case study of a practice-integrated AI platform that demonstrates how trustworthy, generalizable and sustainable AI can be developed, evaluated, and implemented in real-world asthma care. We describe major challenges and solutions based on our real-world experience during the process and offer the practical framework, approaches, tools and workflow for implementing trustworthy, generalizable and sustainable AI in frontline practices.&lt;/div&gt;&lt;div&gt;While A-GPS is an asthma-specific AI tool, it was built on top of a disease-agnostic electronic health record (EHR)-integrated clinical decision support (CDS) platform based on an Application Programming Interface (API)‑first backbone of reusable services. It was designed to reduce chart-review/processing burden and enable proactive, guideline-concordant asthma management by synthesizing fragmented longitudinal multimodal data into a clinical decision-relevant summary at the point of care. A-GPS platform integrates multiple natural language processing (NLP) algorithms to leverage free texts info in EHRs, machine learning model to offer risk stratification, and remote patient monitoring (RPM) approaches to capture real-time data from patients, enabling remote asthma (chronic disease) care. The platform has been deployed via Substitutable Medical Applications and Reusable Technologies-on-Fast Healthcare Interoperability Resources (SMART-on-FHIR) to ensure in-workflow delivery and maintainable governance making it flexible and interoperable across different EHRs systems and different chronic diseases.&lt;/div&gt;&lt;div&gt;The translational maturity of A-GPS as an AI-powered CDS tool for pediatric asthma was demonstrated and sustained through engagement and co-design with diverse community and care team partners, including adult and pediatric Community Advisory Board, pediatric patients and their parents, clinicians (primary care providers and specialists), nurses, schedulers, as well as bioethicists and regulatory experts. Moreover, the tool was evaluated in two randomized clinical trial (RCT)s. The first trial showed a 67% reduction in clinicians’ EHR review time, high clinician satisfaction, potential healthcare cost savings, fairness in model performance, and no adverse events. Trustworthiness was further assessed and supported through fairness evaluation by participant socioeconomic status (SES) using the HOUsing-based SocioEconomic Status (HOUSES) index, human-centered user interface/user experience (UI/UX) analysis, clinician workflow optimization, transparent governance practices, and best practices for regulatory science. The","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 789-816"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13251560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative outcomes: Transforming healthcare","authors":"Odinakachukwu A. Ehie,&nbsp;Arthur W. Wood,&nbsp;Odmara L. Barreto Chang,&nbsp;Erica M. Langnas,&nbsp;Thanh-Giang T. Vu,&nbsp;Maytinee Lilaonitkul,&nbsp;Michael A. Gropper","doi":"10.1016/j.jnma.2026.05.008","DOIUrl":"10.1016/j.jnma.2026.05.008","url":null,"abstract":"<div><div>Health disparities persist across race and ethnicity within our health care system. The environments in which we live and work, and the opportunities and resources available to us contribute to social determinants often inextricable from race and ethnicity that influence and affect our health. While racial and ethnic disparities in perioperative health outcomes have traditionally been attributed to underlying comorbidities, the scope and lens with which social determinants of health play a role are often underestimated. Furthermore, there is limited research on unconscious bias within medicine despite multiple studies that demonstrate minoritized populations inequitably receive lower quality of care. This review article evaluates differences in health outcomes across race and ethnicity as experienced in the preoperative, intraoperative, and postoperative contexts.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 639-650"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences with and reporting racism during medical school","authors":"Gabrina Dixon,&nbsp;Tina Halley,&nbsp;Dewesh Agrawal,&nbsp;Xian Zhao,&nbsp;Craig DeWolfe,&nbsp;Terry Kind","doi":"10.1016/j.jnma.2026.06.014","DOIUrl":"10.1016/j.jnma.2026.06.014","url":null,"abstract":"<div><h3>Purpose</h3><div>To help create an inclusive environment, it is important to understand the experience of racism from medical students. The purpose of this study was to 1) Understand the experience of racism from medical students at two geographically similar medical schools but one being a Predominately White Institution (PWI) and the other a Historically Black College and University (HBCU), 2) Recognize similarities and differences in the racism students experience, and 3) Explore why students do not report the experienced racism.</div></div><div><h3>Methods</h3><div>Third- and fourth-year medical students from HBCU and PWI medical schools were recruited via e-mail for this phenomenological qualitative study. Consent and demographic data were collected via Research Electronic Data Capture (REDCap). Focus groups and one-on-one interviews were conducted via virtual platform by a trained moderator. Transcriptions of the recordings were analyzed by the research team to code and establish themes. The research team collected enough data that, when analyzed, provided sufficiency of information.</div></div><div><h3>Results</h3><div>Four focus groups and 9 one-on-one interviews were conducted with 23 total participants. Students from both medical schools raised 7 common themes and 2 sub-themes involving sources of racism, negative effects of racism, coping mechanisms, and opportunities to combat racism. Students from the HBCU discussed the positive effects of having faculty who share racial concordance with learners. Students from the PWI discussed experiences with racism from attendings. Students from both institutions discussed a fear of reprisal and a sense of futility as barriers to reporting racism.</div></div><div><h3>Conclusion</h3><div>Our study provides a deeper understanding of students’ perspectives of their experiences with racism during their medical education. These insights may support interventions medical schools can take to be anti-racist and inclusive.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 726-733"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial toxicity of stroke: racial and ethnic disparities among working-age and elderly stroke survivors","authors":"Molly M. Jacobs,&nbsp;Charles Ellis Jr.","doi":"10.1016/j.jnma.2026.06.006","DOIUrl":"10.1016/j.jnma.2026.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Financial toxicity refers to the financial strain caused by the costs of medical care, indirect cost, and lost wages. In stroke survivors, financial toxicity is particularly severe due to the high costs of acute care, rehabilitation, and long-term disability resulting from stroke, often leading to delayed care and worse health outcomes. Evaluating variations in the financial toxicity of stroke among racial and ethnic groups is crucial because disparities in healthcare access, socioeconomic status, and insurance coverage can exacerbate the financial burden for certain populations. Understanding these differences can inform policies to reduce inequities for underserved groups.</div></div><div><h3>Methods</h3><div>Individual-level income and wealth values were calculated from self-reported financial data in the Medical Expenditure Panel Survey collected between 2018 and 2021. The analysis employed fixed effects regression to control for unobserved individual heterogeneity, thereby isolating the impact of stroke on income and wealth from other time-invariant personal characteristics with greater accuracy than other analytic methods. Interaction terms were included to assess the differential impacts of stroke on racial and ethnic groups. Due to changing financial dynamics, individuals over age 65 were assessed differentials financial dynamics Heckman regression models tested the robustness of findings to skewness in the distribution of income and wealth.</div></div><div><h3>Results</h3><div>About 2.73% (<em>N </em>= 414) of respondents under age 65 and 10.8% (<em>N </em>= 667) of respondents aged 65 and above reported having had a stroke. After controlling for demographic, health, and household characteristics, stroke was associated with 13% to 15% reduction in income among those less than age 65 and a 16% to 18% reduction is wealth among those age 65 and above. Stroke had a disparate impact on the income of young Black (-10.04%) and Hispanic (-19.19%) respondents and the wealth of older Black (-6.05%) and Hispanic (-3.01%) respondents. These findings were consistent across different model specifications, highlighting the robustness of the results.</div></div><div><h3>Conclusion</h3><div>This study offers robust estimates of the financial impact of stroke indicating significantly difference financial burdens among Black and Hispanic respondents. These findings indicate the need to address the income and wealth impacts of stroke to mitigate financial toxicity in vulnerable populations.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 716-725"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of subclinical cartilage degradation with bone density and trace elements in premenopausal and postmenopausal women with osteopenia and osteoporosis","authors":"Manal Jasim Abbood,&nbsp;Amer H. Abdullah","doi":"10.1016/j.jnma.2026.06.022","DOIUrl":"10.1016/j.jnma.2026.06.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Osteoporosis and osteopenia are major health problems in women, particularly after menopause, and may share pathogenic mechanisms with early osteoarthritic changes. This study evaluated the relationship between bone fragility, oxidative stress, inflammation, trace element imbalance, and subclinical cartilage degradation in Iraqi women.</div></div><div><h3>Materials and methods</h3><div>A total of 120 women aged 24–75 years were enrolled and classified into three groups: control (n = 40), osteopenia (n = 40), and osteoporosis (n = 40) based on BMD and T-scores measured by DEXA. Serum zinc, copper, ferritin, CRP, total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), and cartilage-related biomarkers (Coll2–1NO2, COMP, MMP-3) were determined.</div></div><div><h3>Results</h3><div>Osteopenic and osteoporotic women had significantly lower BMC, BMD, and T-scores, and higher TOS, OSI, CRP, ferritin, and copper, with reduced zinc and TAC compared with controls. Postmenopausal women with osteoporosis showed marked increases in Coll2–1NO2, COMP, and MMP-3. MMP-3 correlated positively with age in both osteopenic and osteoporotic women, while zinc showed a protective inverse association with Coll2–1NO2. Logistic regression identified zinc deficiency, copper excess, oxidative stress markers, and cartilage biomarkers as independent predictors of osteoporosis, with TOS, OSI, and MMP-3 also predicting osteopenia.</div></div><div><h3>Conclusions</h3><div>Zinc deficiency, copper excess, oxidative stress imbalance, and elevated cartilage degradation markers were associated with reduced bone density, particularly in postmenopausal women with osteoporosis. These findings suggest a possible link between bone fragility and subclinical cartilage degradation; however, given the cross-sectional design and modest sample size, these markers should be interpreted as associated biochemical indicators rather than validated biomarkers for risk prediction or early detection.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 734-743"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The underrepresented minority STEMM pipeline is a pipe dream: The pipes rarely connect","authors":"Keith C. Norris,&nbsp;Roland J. Thorpe","doi":"10.1016/j.jnma.2026.06.005","DOIUrl":"10.1016/j.jnma.2026.06.005","url":null,"abstract":"<div><div>Building and sustaining a diverse health care workforce including members of underrepresented groups (URG) requires overcoming an intricate web of structural barriers and their downstream sequelae that conspire to perpetuate underrepresentation of many groups of Americans in science, technology, engineering, math, and medicine (STEMM). These include students from low income, marginalized racial and ethnic minority, gender minority, disabled, female, rural and other groups. Several recent efforts to better recognize and work through these barriers and capture talented URG youth in STEMM have targeted investments mainly at the undergraduate and graduate level, but some even earlier at the K-12 levels. A major strategy of increasing STEMM educational opportunities are short-term URG training programs designed to fill gaps in traditional education systems, that collectively have been termed the biomedical pipeline. Unfortunately, putting more trainees into a series of disconnected and leaky pipes have had only a limited impact and led to funders questioning investment in URG student/trainee pipelines. This is primarily predicated on a belief that the issue is with the ability of the students, when it is the fallacy of the pipeline as presently constructed. While our existing efforts to capture untapped URG talent and develop them into outstanding biomedical scientists and health professionals is crucial to advance the health of our nation, until we embrace and address the root cause of the existing inequities, our ability to improve representation for all groups in the biomedical and health professionals workforce will remain a pipe dream.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 756-763"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling disparities in infections or parasitic disease– and neoplasm-related mortality: A 25-years retrospective analysis using CDC WONDER database","authors":"Dinesh Kumar,&nbsp;Inza Saif,&nbsp;Laiba Jabeen,&nbsp;Maimoona Qayyum,&nbsp;Sumet Kumar,&nbsp;Muhammad Khalid Afridi","doi":"10.1016/j.jnma.2026.04.002","DOIUrl":"10.1016/j.jnma.2026.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Cancer is a leading cause of morbidity and mortality in the United States, with affected individuals facing an increased risk of infection-related mortality due to immune compromise, comorbidities, and treatment effects</div></div><div><h3>Aim</h3><div>To investigate trends and demographics of infection- or parasitic disease-related neoplastic deaths among U.S. adults aged ≥25 years from 1999–2023.</div></div><div><h3>Methods</h3><div>CDC WONDER multiple cause-of-death data (1999–2023) were analyzed for infectious and parasitic diseases (ICD-10: A00–B99) and neoplasms (ICD-10: C00–D48). Crude and age-adjusted mortality rates (AAMRs per 100,000) were computed. Joinpoint regression estimated annual and average percent changes (APC, AAPC) with 95% confidence intervals (p ≤ 0.05), stratified by demographic and geographic characteristics.</div></div><div><h3>Results</h3><div>From 1999–2023, 975,156 deaths involved infections and neoplasms concurrently. AAMR rose from 16.66 to 19.53 per 100,000 (AAPC, 0.75; 95% CI, 0.61–1.00; p &lt; 0.05). Mortality rates increased significantly from 15.52 in 2001 to 16.79 in 2013. (APC, 0.81; p &lt; 0.05), followed by a further rise to 19.52 by 2023 (APC, 1.55; p &lt; 0.05). Older adults (≥65 years) were most affected. Mortality was higher in males than females (22.30 vs 13.00), with both groups mirroring the overall mortality trends (AAPC for females’ and males’: 1.05; p &lt; 0.05 and 0.46; p &lt; 0.05, respectively). Non-Hispanic Blacks had the highest AAMR (27.05), followed by American Indians (17.48), Non-Hispanic Asians (16.52), Hispanics (16.14), and Non-Hispanic Whites (15.80). The West (17.63) and metropolitan areas (17.05) showed the greatest burden, ranging from 11.69 in Montana to 36.68 in the District of Columbia.</div></div><div><h3>Conclusion</h3><div>Infection-related neoplastic mortality increased over 25 years with marked demographic disparities, underscoring the need for targeted interventions.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 567-580"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}