JAMA Network Open最新文献

{"title":"Cumulative Excess Body Mass Index and MGUS Progression to Myeloma.","authors":"Lawrence Liu, Nikhil Grandhi, Mei Wang, Ekaterina Proskuriakova, Theodore Thomas, Martin W Schoen, Kristen M Sanfilippo, Kenneth R Carson, Alissa Visram, Celine Vachon, Graham Colditz, Murali Janakiram, Mengmeng Ji, Su-Hsin Chang","doi":"10.1001/jamanetworkopen.2024.58585","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.58585","url":null,"abstract":"<p><strong>Importance: </strong>Obesity is a risk factor associated with multiple myeloma (MM) and its precursor, monoclonal gammopathy of unknown significance (MGUS). However, it is unclear how cumulative exposure to obesity affects the risk of MGUS progression to MM.</p><p><strong>Objective: </strong>To determine the association of cumulative exposure to excess body mass index (EBMI), defined as BMI (calculated as weight in kilograms divided by height in meters squared) greater than 25, with risk of MGUS progression to MM.</p><p><strong>Design, setting, and participants: </strong>This cohort study included patients with MGUS, including immunoglobin G, immunoglobin A, or light chain MGUS, from the nationwide US Veterans Health Administration database from October 1, 1999, to December 31, 2021. A published natural language processing-assisted model was used to confirm diagnoses of MGUS and progression to MM. Data were analyzed from February 12 to November 4, 2024.</p><p><strong>Exposures: </strong>Cumulative EBMI was calculated by area under the curve of measured BMI subtracting the reference BMI at 25 during the first 3 years after MGUS diagnosis.</p><p><strong>Main outcomes and measures: </strong>The main outcome was progression from MGUS to MM. Multivariable Fine-Gray time-to-competing-event analyses, with death as the competing event, were used to determine associations.</p><p><strong>Results: </strong>The cohort included 22 429 patients with MGUS (median [IQR] age, 70.5 [63.5-77.9] years; 21 613 [96.4%] male), with 8329 Black patients (37.1%) and 14 100 White patients (62.9%). There were 4862 patients (21.7%) with reference range BMI (18.5 to <25), 7619 patients (34.0%) with BMI 25 to less than 30, and 8513 patients (38.0%) with BMI 30 or greater at the time of MGUS diagnosis. Compared with reference range BMI at MGUS diagnosis, patients with BMI 25 to less than 30 (adjusted hazard ratio [aHR], 1.17; 95% CI, 1.03-1.34) or 30 or greater (aHR, 1.27; 95% CI, 1.09-1.47) at MGUS diagnosis had higher risk of progression to MM. In patients with reference range BMI at MGUS diagnosis, each 1-unit increase of EBMI per year was associated with a 21% increase in progression risk (aHR, 1.21; 95% CI, 1.04-1.40). However, for patients with BMI 25 or greater at MGUS diagnosis, the incremental risk associated with cumulative EBMI exposure was not statistically significant.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that, for patients with BMI 18.5 to less than 25 at the time of MGUS diagnosis, cumulative exposure to BMI 25 or greater was associated with an increased risk of progression. These findings suggest that for these patients, maintaining a healthy and stable weight following MGUS diagnosis may prevent progression to MM.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2458585"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364786","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":"Industry Payments and Sentiments Toward Robotic Surgery Among US Physicians.","authors":"Wei San Loh, Andrew M Ibrahim, Sarah Sheskey, Colleen M Stone, Kyle H Sheetz","doi":"10.1001/jamanetworkopen.2024.58552","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.58552","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Given the rapid adoption of robotic surgery and its association with substantial industry payments, objective documentation of physicians' perceptions toward robotic surgery is important.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess US-based physicians' sentiments toward robotic surgery and whether industry payments are associated with their perceptions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study analyzed publicly available posts made from March 19, 2009, to April 1, 2024, by 268 US-based physicians who followed the Society of American Gastrointestinal and Endoscopic Surgeons on X (formerly Twitter). Trainees and individuals without validated clinical practices were excluded. Physicians' specialties were confirmed using the National Provider Identifier Registry.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Payments from Intuitive Surgical Inc, a biotechnology company that manufactures robotic products for use in surgery, were identified via the Open Payments website. Among the physicians, 177 (66.0%) received payments and 91 (34.0%) did not.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Polarity and subjectivity scores of social media posts shared by physicians. Polarity was scored from -1 to 1, with higher scores reflecting more positive sentiment, lower scores reflecting more negative sentiment, and 0 indicating neutrality. Subjectivity was scored from 0 to 1, with higher scores reflecting more subjective opinions and lower scores reflecting objective facts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study comprised 268 physicians (154 men [57.5%], 68 women [25.4%], and 46 physicians [17.2%] with sex not reported; 113 general surgeons [42.2%] and 155 physicians in surgical subspecialties [57.8%]). The overall sentiment scores ranged from -0.25 to 0.5 (mean [SD] score, 0.1 [0.2]; 95% CI, 0.09-0.13) and subjectivity scores ranged from 0 to 0.9 (mean [SD] score, 0.4 [0.2]; 95% CI, 0.38-0.41), suggesting that posts were relatively objective with occasional personal insights. No significant difference was seen in mean polarity scores between the 177 physicians who received payments and the 91 physicians who did not (mean [SD] score, 0.12 [0.2]; 95% CI, 0.09-0.14 vs 0.1 [0.2]; 95% CI, 0.07-0.14). Physicians posting before and after receiving industry payments showed consistent positive sentiments (median polarity, 0.1 [IQR, 0.03-0.21]) and decreased subjectivity after receiving payment. Physicians in the top 25% of payment distribution had more positive sentiments and increased subjectivity after receiving payments, whereas those in the bottom 75% showed little change.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study of US-based physicians, publicly available social media data were used to quantify perceptions of robotic surgery. These findings demonstrate the potential of such data to inform health care practices, guide balanced information dissemination, and uphold the integri","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2458552"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364800","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":"Pediatric Gastrointestinal Tract Outcomes During the Postacute Phase of COVID-19.","authors":"Dazheng Zhang, Ronen Stein, Yiwen Lu, Ting Zhou, Yuqing Lei, Lu Li, Jiajie Chen, Jonathan Arnold, Michael J Becich, Elizabeth A Chrischilles, Cynthia H Chuang, Dimitri A Christakis, Daniel Fort, Carol R Geary, Mady Hornig, Rainu Kaushal, David M Liebovitz, Abu S M Mosa, Hiroki Morizono, Parsa Mirhaji, Jennifer L Dotson, Claudia Pulgarin, Marion R Sills, Srinivasan Suresh, David A Williams, Robert N Baldassano, Christopher B Forrest, Yong Chen","doi":"10.1001/jamanetworkopen.2024.58366","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.58366","url":null,"abstract":"<p><strong>Importance: </strong>The profile of gastrointestinal (GI) tract outcomes associated with the postacute and chronic phases of COVID-19 in children and adolescents remains unclear.</p><p><strong>Objective: </strong>To investigate the risks of GI tract symptoms and disorders during the postacute (28-179 days after documented SARS-CoV-2 infection) and the chronic (180-729 days after documented SARS-CoV-2 infection) phases of COVID-19 in the pediatric population.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study was performed from March 1, 2020, to September 1, 2023, at 29 US health care institutions. Participants included pediatric patients 18 years or younger with at least 6 months of follow-up. Data analysis was conducted from November 1, 2023, to February 29, 2024.</p><p><strong>Exposures: </strong>Presence or absence of documented SARS-CoV-2 infection. Documented SARS-CoV-2 infection included positive results of polymerase chain reaction analysis, serological tests, or antigen tests for SARS-CoV-2 or diagnosis codes for COVID-19 and postacute sequelae of SARS-CoV-2.</p><p><strong>Main outcomes and measures: </strong>GI tract symptoms and disorders were identified by diagnostic codes in the postacute and chronic phases following documented SARS-CoV-2 infection. The adjusted risk ratios (ARRs) and 95% CI were determined using a stratified Poisson regression model, with strata computed based on the propensity score.</p><p><strong>Results: </strong>The cohort consisted of 1 576 933 pediatric patients (mean [SD] age, 7.3 [5.7] years; 820 315 [52.0%] male). Of these, 413 455 patients had documented SARS-CoV-2 infection and 1 163 478 did not; 157 800 (13.6%) of those without documented SARS-CoV-2 infection had a complex chronic condition per the Pediatric Medical Complexity Algorithm. Patients with a documented SARS-CoV-2 infection had an increased risk of developing at least 1 GI tract symptom or disorder in both the postacute (8.64% vs 6.85%; ARR, 1.25; 95% CI, 1.24-1.27) and chronic (12.60% vs 9.47%; ARR, 1.28; 95% CI, 1.26-1.30) phases compared with patients without a documented infection. Specifically, the risk of abdominal pain was higher in COVID-19-positive patients during the postacute (2.54% vs 2.06%; ARR, 1.14; 95% CI, 1.11-1.17) and chronic (4.57% vs 3.40%; ARR, 1.24; 95% CI, 1.22-1.27) phases.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, the increased risk of GI tract symptoms and disorders was associated with the documented SARS-CoV-2 infection in children or adolescents during the postacute or chronic phase. Clinicians should note that lingering GI tract symptoms may be more common in children after documented SARS-CoV-2 infection than in those without documented infection.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2458366"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364859","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":"Standardized Management of Direct Oral Anticoagulants for Elective Procedures.","authors":"Alex C Spyropoulos, James D Douketis","doi":"10.1001/jamanetworkopen.2024.58739","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.58739","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2458739"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364864","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":"Large Language Models for Chatbot Health Advice Studies: A Systematic Review.","authors":"Bright Huo, Amy Boyle, Nana Marfo, Wimonchat Tangamornsuksan, Jeremy P Steen, Tyler McKechnie, Yung Lee, Julio Mayol, Stavros A Antoniou, Arun James Thirunavukarasu, Stephanie Sanger, Karim Ramji, Gordon Guyatt","doi":"10.1001/jamanetworkopen.2024.57879","DOIUrl":"10.1001/jamanetworkopen.2024.57879","url":null,"abstract":"<p><strong>Importance: </strong>There is much interest in the clinical integration of large language models (LLMs) in health care. Many studies have assessed the ability of LLMs to provide health advice, but the quality of their reporting is uncertain.</p><p><strong>Objective: </strong>To perform a systematic review to examine the reporting variability among peer-reviewed studies evaluating the performance of generative artificial intelligence (AI)-driven chatbots for summarizing evidence and providing health advice to inform the development of the Chatbot Assessment Reporting Tool (CHART).</p><p><strong>Evidence review: </strong>A search of MEDLINE via Ovid, Embase via Elsevier, and Web of Science from inception to October 27, 2023, was conducted with the help of a health sciences librarian to yield 7752 articles. Two reviewers screened articles by title and abstract followed by full-text review to identify primary studies evaluating the clinical accuracy of generative AI-driven chatbots in providing health advice (chatbot health advice studies). Two reviewers then performed data extraction for 137 eligible studies.</p><p><strong>Findings: </strong>A total of 137 studies were included. Studies examined topics in surgery (55 [40.1%]), medicine (51 [37.2%]), and primary care (13 [9.5%]). Many studies focused on treatment (91 [66.4%]), diagnosis (60 [43.8%]), or disease prevention (29 [21.2%]). Most studies (136 [99.3%]) evaluated inaccessible, closed-source LLMs and did not provide enough information to identify the version of the LLM under evaluation. All studies lacked a sufficient description of LLM characteristics, including temperature, token length, fine-tuning availability, layers, and other details. Most studies (136 [99.3%]) did not describe a prompt engineering phase in their study. The date of LLM querying was reported in 54 (39.4%) studies. Most studies (89 [65.0%]) used subjective means to define the successful performance of the chatbot, while less than one-third addressed the ethical, regulatory, and patient safety implications of the clinical integration of LLMs.</p><p><strong>Conclusions and relevance: </strong>In this systematic review of 137 chatbot health advice studies, the reporting quality was heterogeneous and may inform the development of the CHART reporting standards. Ethical, regulatory, and patient safety considerations are crucial as interest grows in the clinical integration of LLMs.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2457879"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189347","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":"Error in Byline.","authors":"","doi":"10.1001/jamanetworkopen.2025.0502","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0502","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e250502"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255732","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":"Rest-Activity Rhythms, Their Modulators, and Brain-Clinical Correlates in Opioid Use Disorder.","authors":"Rui Zhang, Peter Manza, Sukru Baris Demiral, Dardo Tomasi, Michele-Vera Yonga, Weizheng Yan, Ehsan Shokri-Kojori, Melanie Schwandt, Leah Vines, Diana Sotelo, Christina Lildharrie, Esther Lin, Natasha T Giddens, Gene-Jack Wang, Nora D Volkow","doi":"10.1001/jamanetworkopen.2024.57976","DOIUrl":"10.1001/jamanetworkopen.2024.57976","url":null,"abstract":"<p><strong>Importance: </strong>Sleep and circadian disruptions are highly prevalent in opioid use disorder (OUD) and are a barrier to successful treatment and recovery; yet few objective data are available, especially for individuals in OUD treatment with opioid agonist therapy. If disruptions remain present despite OUD treatment, this information would yield potential new targets for adjunctive therapy.</p><p><strong>Objective: </strong>To systematically investigate different aspects of rest-activity rhythms (RAR), including sleep, physical activity, circadian rhythmicity, and brain functional correlates in individuals with OUD.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study conducted from October 12, 2017, through January 11, 2024, recruited participants with OUD from treatment programs or the community in the District of Columbia, Maryland, and Virginia area. Participants included individuals with OUD treated with methadone or buprenorphine, individuals with OUD who remained abstinent without medications, and healthy controls (HCs). Healthy participants were recruited from advertisements. Statistical analyses were conducted between March 1 and May 31, 2024.</p><p><strong>Main outcomes and measures: </strong>In total, 21 RAR features were derived from 1-week actigraphy data, and principal components were used to extract independent RAR components. Modulators and brain and clinical correlates of RAR were also examined.</p><p><strong>Results: </strong>This study included 73 participants (46 [63%] male; mean [SD] age, 43.5 [11.3] years). Among 42 patients with OUD (16 [38%] female; mean [SD] age, 42.7 [11.4] years), 33 receiving medications for opioid use disorder (MOUD) exhibited greater sleep-wake irregularity than 9 patients without MOUD (mean difference, 0.85 [95% CI, 0.00-1.69]) or 31 age- and sex-matched HCs (11 [36%] female; mean [SD] age, 44.5 [11.3] years; mean difference, 0.75 [95% CI, 0.19-1.31). Among participants receiving MOUD, greater sleep irregularity was associated with longer heroin use history (r26 = 0.45; P = .02) and lower daytime light exposure (r33 = -0.57; P < .001). Compared with HCs, participants with OUD exhibited lower fractional occupancy (percentage of occurrence) in a default mode network-dominated brain state, with individuals experiencing more pronounced sleep-wake irregularities displaying exacerbated impairments (r23 = -0.55; P = .007).</p><p><strong>Conclusions and relevance: </strong>Findings of this cross-sectional study showed that sleep irregularity in participants with OUD receiving opioid agonist medications correlated with years of opioid misuse and shorter daylight exposures and was associated with impaired brain state dynamics. These findings suggest that interventions increasing light exposure may improve sleep-wake irregularity and brain functional network dynamics in individuals with OUD receiving opioid agonist medications.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2457976"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189361","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":"Return on Investment of Enhanced Behavioral Health Services.","authors":"Matt Hawrilenko, Casey Smolka, Emily Ward, Geetu Ambwani, Millard Brown, Anita Mohandas, Martin Paulus, John Krystal, Adam Chekroud","doi":"10.1001/jamanetworkopen.2024.57834","DOIUrl":"10.1001/jamanetworkopen.2024.57834","url":null,"abstract":"<p><strong>Importance: </strong>Employer-sponsored benefit programs aim to increase access to behavioral health care, which may help contain health care costs. However, research has either focused solely on clinical outcomes or demonstrated reductions in medical claims without accounting for the costs of behavioral health services, leaving the financial return on investment unknown.</p><p><strong>Objective: </strong>To determine whether a clinically effective employer-sponsored behavioral health benefit is associated with net medical cost savings.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included participants eligible for an employer-sponsored behavioral health benefit between November 1, 2019, and May 31, 2023. Eligibility criteria included having a behavioral health diagnosis and, in the program group, attending at least 1 behavioral health appointment. Program users were matched to nonusers on medical risk scores, behavioral health diagnoses, date of diagnosis, age, sex, and employer. Participants were followed up for 1 year before and after the benefit launch.</p><p><strong>Exposure: </strong>A digital platform screened individuals for common behavioral health conditions and provided access to video and in-person psychotherapy, medication management, care navigation, and self-guided digital content.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were per member per month (PMPM) medical spending, inclusive of all medical claims and program costs. A difference-in-differences analysis was used to compare changes in net medical spending between groups from the year before and up to 1 year after an index mental health diagnosis.</p><p><strong>Results: </strong>This study included 13 990 participants: 4907 of 4949 (99.1%) eligible program group members were matched to 9083 control participants. Their mean (SD) age was 37 (13.2) years, and most participants (65.5%) were female. Costs decreased in the program group relative to the control group, with a net difference-in-differences of -$164 PMPM (95% CI, -$228 to -$100 PMPM), corresponding to savings of $1070 per participant in the first program year and a return on investment of 1.9 times the costs (ie, every $100 invested reduced medical claims costs by $190). Behavioral health costs in the program group increased relative to the control group but were more than offset by decreases in physical health care costs. Savings were larger for participants with higher medical risk.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, every $100 invested in an employer-sponsored behavioral health program with fast access to psychotherapy and medication management was associated with a reduction in medical claims costs by $190. These findings suggest that expanding access to behavioral health care may be a financially viable cost-reduction strategy for health care buyers.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2457834"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189377","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":"Socioeconomic and Geographic Differences in Mammography Trends Following the 2009 USPSTF Policy Update.","authors":"Jason Semprini, Loren Saulsberry, Olufunmilayo I Olopade","doi":"10.1001/jamanetworkopen.2024.58141","DOIUrl":"10.1001/jamanetworkopen.2024.58141","url":null,"abstract":"<p><strong>Importance: </strong>In 2024, the US Preventive Services Task Force (USPSTF) reversed a 2009 policy recommending only females aged 50 to 74 years complete a biennial mammogram. Understanding whether females facing heterogeneous breast cancer risks responded to the 2009 guidance may illuminate how they may respond to the latest policy update.</p><p><strong>Objective: </strong>To evaluate whether the 2009 policy was associated with changes in mammography screening in females no longer recommended to complete a biennial mammogram and whether these changes varied by factors associated with breast cancer risk.</p><p><strong>Design, setting, and participants: </strong>The difference-in-differences design compared biennial mammogram trends in the exposed groups (aged 40-49 and ≥75 years) with trends of the unexposed groups (aged 50-64 and 65-74 years), before and after the 2009 update. Population-based, repeated cross-sectional survey data came from the Behavioral Risk Factor Surveillance System (BRFSS) biennial cancer screening module (2000-2018). The sample was restricted to females between ages 40 and 84 years. Data were analyzed from March 1 to June 30, 2024.</p><p><strong>Main outcomes and measures: </strong>The outcome was a binary variable indicating whether the respondent reported a mammogram in the past 2 years (biennial). After 2009, females aged 40 to 49 and 75 or older years were exposed to the policy update, as a complete biennial mammogram was recommended. Subgroup analyses included race and ethnicity, educational level, household income, smoking history, current binge drinking status, and state of residence.</p><p><strong>Results: </strong>The sample included 1 594 834 females; 75% reported a biennial mammogram. In those aged 40 to 49 years, the USPSTF update was associated with a 1.1 percentage-point (95% CI, -1.8% to -0.3 percentage points) decrease in the probability of a biennial mammogram, with the largest decreases in the non-Hispanic Black population (-3.0 percentage points; 95% CI, -5.5% to -0.5 percentage points). In the aged 75 years or older group, the USPSTF update was associated with a 4.8 percentage-point decrease (95% CI, -6.3% to -3.5 percentage points) in the probability of a biennial mammogram, with significant heterogeneity by race and ethnicity, binge drinking status, and state residence.</p><p><strong>Conclusions and relevance: </strong>In this study, socioeconomic factors were associated with differences in how females responded to the 2009 USPSTF mammography recommendation. Whether the 2024 update considered such differences is unclear. These findings suggest that including risk assessment into future USPSTF policy updates may improve adoption of risk-reducing interventions and shorten the time to diagnosis and treatment for high-risk patients.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e2458141"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189382","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":"JAMA Network Open.","authors":"","doi":"10.1001/jamanetworkopen.2025.0427","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0427","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 2","pages":"e250427"},"PeriodicalIF":10.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080128","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}