JAMA Network Open最新文献

{"title":"Valuing Clinical Strategies Immediately After FDA Approval.","authors":"Charles L Bennett, Kevin B Knopf","doi":"10.1001/jamanetworkopen.2025.0043","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0043","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250043"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542169","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}

{"title":"Prior Authorization, Quantity Limits, and Costs for Varenicline in Medicare.","authors":"Changchuan Jiang, Ryan D Nipp, Arthur S Hong, Ya-Chen Tina Shih, Jiazhang Xing, Megan A Mullins, K Robin Yabroff, Joshua M Liao","doi":"10.1001/jamanetworkopen.2025.0008","DOIUrl":"10.1001/jamanetworkopen.2025.0008","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250008"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542068","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}

{"title":"Smoking and Complications After Cancer Surgery: A Systematic Review and Meta-Analysis.","authors":"Clement Wong, Siti Khadijah Binti Mohamad Asfia, Paul S Myles, John Cunningham, Elizabeth M Greenhalgh, Emma Dean, Sally Doncovio, Lisa Briggs, Nicholas Graves, Nikki McCaffrey","doi":"10.1001/jamanetworkopen.2025.0295","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0295","url":null,"abstract":"<p><strong>Importance: </strong>Surgical cancer treatments may be delayed for patients who smoke over concerns for increased risk of complications. Quantifying risks for people who had recently smoked can inform any trade-offs of delaying surgery.</p><p><strong>Objective: </strong>To investigate the association between smoking status or smoking cessation time and complications after cancer surgery.</p><p><strong>Data sources: </strong>Embase, CINAHL, Medline COMPLETE, and Cochrane Library were systematically searched for studies published from January 1, 2000, to August 10, 2023.</p><p><strong>Study selection: </strong>Observational and interventional studies comparing the incidence of complications in patients undergoing cancer surgery who do and do not smoke.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers screened results and extracted data according to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Data were pooled with a random-effects model and adjusted analysis was performed.</p><p><strong>Main outcomes and measures: </strong>The odds ratio (OR) of postoperative complications (of any type) for people who smoke currently vs in the past (4-week preoperative cutoff), currently smoked vs never smoked, and smoked within shorter (2-week cutoff) and longer (1-year cutoff) time frames.</p><p><strong>Results: </strong>The meta-analyses across 24 studies with a pooled sample of 39 499 participants indicated that smoking within 4 weeks preoperatively was associated with higher odds of postoperative complications compared with ceasing smoking for at least 4 weeks (OR, 1.31 [95% CI, 1.10-1.55]; n = 14 547 [17 studies]) and having never smoked (OR, 2.83 [95% CI, 2.06-3.88]; n = 9726 [14 studies]). Within the shorter term, there was no statistically significant difference in postoperative complications between people who had smoked within 2 weeks preoperatively and those who had stopped between 2 weeks and 3 months in postoperative complications (OR, 1.19 [95% CI, 0.89-1.59]; n = 5341 [10 studies]), although the odds of complications among people who smoked within a year of surgery were higher compared with those who had quit smoking for at least 1 year (OR, 1.13 [95% CI, 1.00-1.29]; N = 31 238 [13 studies]). The results from adjusted analyses were consistent with the key findings.</p><p><strong>Conclusions and relevance: </strong>In this systematic review and meta-analysis of smoking cessation and complications after cancer surgery, people with cancer who had stopped smoking for at least 4 weeks before surgery had fewer postoperative complications than those smoking closer to surgery. High quality, intervention-based evidence is needed to identify the optimal cessation period and inform clinicians on the trade-offs of delaying cancer surgery.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250295"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572985","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}

{"title":"Strategies to Assess Risk for Hereditary Cancer in Primary Care Clinics: A Cluster Randomized Clinical Trial.","authors":"Elizabeth M Swisher, Heather M Harris, Sarah Knerr, Tesla N Theoryn, Barbara M Norquist, Jeannine Brant, Brian H Shirts, Faith Beers, DaLaina Cameron, Emerson J Dusic, Laurie A Riemann, Beth Devine, Michael L Raff, Rabindra Kadel, Howard J Cabral, Catharine Wang","doi":"10.1001/jamanetworkopen.2025.0185","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0185","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Best practices for improving access to assessment of hereditary cancer risk in primary care are lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare 2 population-based engagement strategies for identifying primary care patients with a family or personal history of cancer and offering eligible individuals genetic testing for cancer susceptibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;The EDGE (Early Detection of Genetic Risk) clinical trial cluster-randomized 12 clinics from 2 health care systems in Montana, Wyoming, and Washington state to 1 of 2 engagement approaches for assessment of hereditary cancer risk in primary care. The study population included 95 623 English-speaking patients at least 25 years old with a primary care visit during the recruitment window between April 1, 2021, and March 31, 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;The intervention comprised 2 risk assessment engagement approaches: (1) point of care (POC), conducted by staff immediately preceding clinical appointments, and (2) direct patient engagement (DPE), where letter and email outreach facilitated at-home completion. Patients who completed risk assessment and met prespecified criteria were offered genetic testing via a home-delivered saliva testing kit at no cost.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary outcomes were the proportion of patients with a visit who (1) completed the risk assessment and (2) completed genetic testing. Logistic regression models were used to compare the POC and DPE approaches, allowing for overdispersion and including clinic as a design factor. An intention-to-treat analysis was used to evaluate primary outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over a 12-month window, 95 623 patients had a primary care visit across the 12 clinics. Those who completed the risk assessment (n = 13 705) were predominately female (64.7%) and aged between 65 and 84 years (39.6%). The POC approach resulted in a higher proportion of patients completing risk assessment than the DPE approach (19.1% vs 8.7%; adjusted odds ratio [AOR], 2.68; 95% CI, 1.72-4.17; P &lt; .001) but a similar proportion completing testing (1.5% vs 1.6%; AOR, 0.96; 95% CI, 0.64-1.46; P = .86). Among those eligible for testing, POC test completion was approximately half of that for the DPE approach (24.7% vs 44.7%; AOR, 0.49; 95% CI, 0.37-0.64; P &lt; .001). The proportion of tested patients identified with an actionable pathogenic variant was significantly lower for the POC approach than the DPE approach (3.8% vs 6.6%; AOR, 0.61; 95% CI, 0.44-0.85; P = .003).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cluster randomized clinical trial of risk assessment delivery, POC engagement resulted in a higher rate of assessment of hereditary cancer risk than the DPE approach but a similar rate of genetic testing completion. Using a combination of engagement strategies may be the optimal approach for greater reach and impa","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250185"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572988","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}

{"title":"From Gestational Diabetes to Type 2 Diabetes-Is Poor Sleep to Blame?","authors":"Christian Benedict, Marie-Pierre St-Onge","doi":"10.1001/jamanetworkopen.2025.0149","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0149","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250149"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556973","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}

{"title":"Changes in Respiratory Viral Testing Before and After the COVID-19 Pandemic.","authors":"Todd W Lyons, Caroline G Kahane","doi":"10.1001/jamanetworkopen.2025.0168","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0168","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250168"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567180","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}

{"title":"Intentional Weight Loss, Waist Circumference Reduction, and Mortality Risk Among Postmenopausal Women.","authors":"Michael Hendryx, JoAnn E Manson, Robert J Ostfeld, Rowan T Chlebowski, Erin S LeBlanc, Molly E Waring, Wendy E Barrington, Marisa A Bittoni, Sylvia Wassertheil-Smoller, Jackie Gofshteyn Herold, Juhua Luo","doi":"10.1001/jamanetworkopen.2025.0609","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0609","url":null,"abstract":"<p><strong>Importance: </strong>Research investigating weight loss and mortality risk often fails to differentiate between intentional and unintentional weight loss and typically uses body mass index (BMI) as the measure of excess body weight.</p><p><strong>Objective: </strong>To evaluate associations between weight loss and waist circumference (WC) reduction and mortality, considering weight loss intentionality.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the Women's Health Initiative Observational Study, which had a prospective cohort with mean follow-up of 18.6 years ending in February 2023. The study included women aged 50 to 79 years at 40 clinical centers in the US. Women with missing data, cancer at baseline, or considered underweight at baseline were excluded. Data were collected from September 1993 to February 2023 and were analyzed from June to December 2024.</p><p><strong>Exposures: </strong>Measured weight loss and WC reduction between baseline and year 3, stratified by women who reported intentional weight loss or not.</p><p><strong>Main outcomes and measures: </strong>Outcomes included adjudicated all-cause, cancer, cardiovascular, and other mortality through the end of follow-up. Cox proportional hazards regression models were used to evaluate the associations (hazard ratios [HRs] and 95% CIs) between weight loss, WC reduction, and mortality over 18.6 years of follow-up.</p><p><strong>Results: </strong>This study included 58 961 women at baseline (mean [SD] age, 63.3 [7.2] years; mean [SD] BMI, 27.0 [5.6]; mean [SD] WC, 84.1 [13.0] cm). As of February 28, 2023, 29 183 women (49.5%) died from all causes. Intentional weight loss measured by questionnaire was associated with lower subsequent mortality rates for all-cause mortality (HR, 0.88; 95% CI, 0.86-0.90), cancer mortality (HR, 0.87; 95% CI, 0.82-0.92), cardiovascular mortality (HR, 0.87; 95% CI, 0.83-0.91), and other mortality (HR, 0.89; 95% CI, 0.86-0.92), comparing loss of 5 pounds or more to stable weight. Reported intentional weight loss coupled with actual weight reduction of 5% or more was associated only with lower cardiovascular mortality (HR, 0.90; 95% CI, 0.81-0.99). Reported intentional weight loss coupled with measured WC loss was associated with lower rates of all-cause mortality (HR, 0.91; 95% CI, 0.86-0.95), cancer mortality (HR, 0.85; 95% CI, 0.76-0.95), and cardiovascular mortality (HR, 0.79; 95% CI, 0.72-0.87). Unintentional weight loss or unintentional WC loss were each associated with increased mortality risk for all groups, as were weight gain and WC gain.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, reported intentional weight loss efforts that were coupled with measured WC reductions were associated with lower risk of all-cause, cancer, and cardiovascular mortality. Attention to diet and exercise that promote reductions in central adiposity should be encouraged.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250609"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567188","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}

{"title":"Naloxone Knowledge, Carrying, Purchase, and Use.","authors":"Mireille Jacobson, David Powell","doi":"10.1001/jamanetworkopen.2024.62698","DOIUrl":"10.1001/jamanetworkopen.2024.62698","url":null,"abstract":"<p><strong>Importance: </strong>Widespread naloxone access is a key policy response to the opioid crisis. Naloxone availability is typically estimated from pharmacy sales, which exclude naloxone provided by community organizations, hospitals, and clinics, or sold over-the-counter.</p><p><strong>Objective: </strong>To estimate naloxone knowledge, carrying, purchase, and use among US adults.</p><p><strong>Design, setting, and participants: </strong>This survey study included noninstitutionalized adults aged 18 years and older from a national sample and a sample self-reporting opioid dependence. Respondents answered online questions between June 7 and June 29, 2024, about naloxone knowledge, carrying, purchase, and use.</p><p><strong>Exposures: </strong>Opioid misuse, risk of overdose, risk of overdose by person known to respondent.</p><p><strong>Main outcomes and measures: </strong>Naloxone knowledge, prevalence of naloxone carrying, purchase, and administration.</p><p><strong>Results: </strong>The survey included 1515 individuals from a national sample (median [IQR] age, 45 [33-58] years; 770 women [50.8%]; 215 Black [14.2%], 1087 White [71.8%]) and 512 who self-reported opioid dependence. In the national sample, 50 respondents (3.3%) reported opioid dependence, yielding 562 respondents reporting opioid dependence (median [IQR] age, 41 [35-48] years; 404 female [70.2%]; 17 Black [3.0%], 494 White [87.9%]). Overall, 1164 respondents-700 (46.2%) in the national sample and 500 (89.0%) reporting opioid dependence-had heard of naloxone and correctly identified its purpose. One hundred sixty participants (10.6%) in the national sample and 340 participants (60.5%) in the sample reporting opioid dependence reported carrying naloxone. Among those reporting they were \"very likely to overdose,\" 22 respondents (31.0%) in the national sample and 31 (73.8%) with opioid dependence reported carrying naloxone. Among those who know someone very likely to overdose, 43 participants (25.4%) in the national sample and 190 participants (70.1%) reporting opioid dependence reported carrying naloxone. Among those who ever carried naloxone, 108 (42.4%) in the national sample and 97 (22.6%) reporting opioid dependence had ever purchased naloxone. Overall, 128 respondents (8.4%) in the national sample and 267 respondents (47.5%) reporting opioid dependence reported administering naloxone to someone else while 93 (6.1%) in the national sample and 221 (39.3%) reporting opioid dependence reported being administered naloxone.</p><p><strong>Conclusions and relevance: </strong>In this survey study of naloxone, most respondents reporting opioid dependence correctly identified naloxone's purpose and carried it. Most naloxone carried was not purchased, suggesting a need for new ways, including rapid online surveys, to monitor naloxone possession.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e2462698"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542113","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}

{"title":"Cost-Effectiveness of Pembrolizumab With Chemoradiotherapy for Locally Advanced Cervical Cancer.","authors":"P Travis Courtney, Puja S Venkat, Ya-Chen Tina Shih, Albert J Chang, Alan Lee, Michael L Steinberg, Ann C Raldow","doi":"10.1001/jamanetworkopen.2025.0033","DOIUrl":"10.1001/jamanetworkopen.2025.0033","url":null,"abstract":"<p><strong>Importance: </strong>The KEYNOTE-A18 trial demonstrated that adding concurrent and adjuvant pembrolizumab to chemoradiotherapy and brachytherapy significantly improved survival in patients with newly diagnosed, locally advanced cervical cancer. However, considering the annual global incidence of 660 000 cases of cervical cancer, including 13 820 in the US in 2024, incorporating this regimen into the standard of care could have substantial health care economic implications for both patients and the health care system.</p><p><strong>Objective: </strong>To determine the cost-effectiveness of adding pembrolizumab to the first-line treatment of newly diagnosed, locally advanced cervical cancer.</p><p><strong>Design, setting, and participants: </strong>This economic evaluation created a Markov model simulating 50-year outcomes to evaluate cost-effectiveness from the payer perspective for patients receiving either pembrolizumab or placebo in addition to chemoradiotherapy plus brachytherapy. Probabilities, including disease progression, survival, and treatment-related toxic effects, were derived from KEYNOTE-A18 clinical trial data in patients with newly diagnosed, locally advanced cervical cancer. Costs and health utilities were obtained from published literature; 1-way, 3-way, and probabilistic sensitivity analyses were used to assess model uncertainty. Data analyses were conducted from April to November 2024.</p><p><strong>Exposure: </strong>Pembrolizumab.</p><p><strong>Main outcomes and measures: </strong>Costs, measured in 2024 US dollars, and effectiveness, measured in quality-adjusted life-years (QALYs) were used to calculate an incremental cost-effectiveness ratio (ICER). A willingness-to-pay threshold of $100 000 per QALY was chosen, below which pembrolizumab would be considered cost-effective.</p><p><strong>Results: </strong>KEYNOTE-A18 enrolled 1060 patients (529 in pembrolizumab group, 531 in placebo group). The median age was 50 years. Pembrolizumab increased costs by $257 000 and effectiveness by 1.40 QALYs, yielding an incremental cost-effectiveness ratio of $183 400 per QALY. The addition of pembrolizumab became cost-effective if its monthly cost was decreased from $16 990 to $9190 (a 45.6% reduction) or its maximum duration of 24 months was decreased to 10 months. The model was insensitive to assumptions about treatment-related toxic effects, progression-free survival, and overall survival. Probabilistic sensitivity analysis indicated that at a willingness-to-pay threshold of $100 000 per QALY, the addition of pembrolizumab was cost-effective 37.3% of the time.</p><p><strong>Conclusions and relevance: </strong>In this economic evaluation of adding concurrent and adjuvant pembrolizumab to first-line treatment of newly diagnosed, locally advanced cervical cancer, this regimen was not cost-effective at current prices despite data demonstrating improved survival with this regimen.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250033"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541967","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}

{"title":"Veterans at High Risk for Post-COVID-19 Suicide Attempts or Other Self-Directed Violence.","authors":"David P Bui, Meike Niederhausen, Alex W Hickok, Diana J Govier, Mazhgan Rowneki, Jennifer C Naylor, Eric Hawkins, Edward J Boyko, Theodore J Iwashyna, Elizabeth M Viglianti, George N Ioannou, Jason I Chen, Denise M Hynes","doi":"10.1001/jamanetworkopen.2025.0061","DOIUrl":"10.1001/jamanetworkopen.2025.0061","url":null,"abstract":"<p><strong>Importance: </strong>US veterans have a higher risk of suicide than the general civilian population. Research suggests that COVID-19 infection is associated with increased risk of suicide attempts or other forms of self-directed violence (SDV) among veterans.</p><p><strong>Objective: </strong>To identify subgroups of veterans with high risk of post-COVID-19 suicide attempts or SDV.</p><p><strong>Design, setting, and participants: </strong>This is a retrospective cohort study conducted using data from the Veteran Health Administration (VHA). Participants included VHA enrollees with a first case of COVID-19 between May 1, 2021, and April 30, 2022, residing in the 50 states or Washington, DC.</p><p><strong>Exposure: </strong>COVID-19 infection.</p><p><strong>Main outcomes and measures: </strong>The main outcome was a suicide attempt or SDV 12 months after COVID-19 infection. Latent class analysis was used to identify subgroups. Outcome rates and 95% CIs per 10 000 veterans were calculated. Multinomial regressions were used to model outcome risk and marginal risk ratios with 99.5% CIs to compare outcome risk across latent classes.</p><p><strong>Results: </strong>The cohort included 285 235 veterans with COVID-19 and was predominantly male (248 118 veterans [87.0%]) and younger than 65 years (171 636 veterans [60.2%]). Chronic pain (152 788 veterans [53.6%]), depression (98 093 veterans [34.4%]), and posttraumatic stress disorder (79 462 veterans [27.9%]) diagnoses were common. The 12-month outcome rate was 73.8 events per 10 000 (95% CI, 70.7-77.0 events per 10 000). Two latent classes with high rates of suicide attempt or SDV were identified. The first high-risk subgroup (46 693 veterans [16.4%]) was older (34 472 veterans [73.8%] aged ≥65 years) and had a high prevalence of physical conditions (43 329 veterans [92.8%] had hypertension, and 36 824 veterans [78.9%] had chronic pain); the 12-month outcome rate was 103.7 events per 10 000 (95% CI, 94.7-113.3 events per 10 000). The second high-risk subgroup (82 309 veterans [28.9%]) was generally younger (68 822 veterans [83.6%] aged <65 years) with a lower prevalence of physical conditions but high prevalence of mental health conditions (61 367 veterans [74.6%] had depression, and 50 073 veterans [60.8%] had posttraumatic stress disorder); the 12-month outcome rate was 162.9 events per 10 000 (95% CI, 154.5-171.8 events per 10 000), and compared with the lowest risk subgroup, the 12-month risk of suicide attempts or SDV was 14 times higher in this subgroup (risk ratio, 14.23; 99.5% CI, 10.22-19.80).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of veterans with COVID-19, 2 veteran subgroups with distinct health profiles had high rates of suicide attempts and SDV, suggesting that different groups may require different approaches to suicide prevention after COVID-19.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250061"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542176","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}