JAMA Network Open最新文献

{"title":"Generating Timely Estimates of Overdose Deaths for the US Using Urine Drug Test Data.","authors":"John V Myers, Charles Marks, Joanne Kim, Naleef Fareed, Neena Thomas, Penn Whitley, Soledad Fernandez","doi":"10.1001/jamanetworkopen.2025.14402","DOIUrl":"10.1001/jamanetworkopen.2025.14402","url":null,"abstract":"<p><strong>Importance: </strong>Provisional estimates of fatal drug overdoses in the US are lagging by 6 months. Efforts to estimate the overdose burden for this 6-month lag window require up-to-date data, such as real-time urine drug test (UDT) data, capable of identifying sudden changes in the overdose trajectory, such as the increase in overdose deaths experienced at the beginning of the COVID-19 pandemic.</p><p><strong>Objective: </strong>To evaluate the utility of using aggregated UDT data to estimate national-level drug overdose deaths for the 6-month lag window in which overdose data are unavailable.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included 3 135 748 urine samples submitted for UDT by Millennium Health from patients aged 18 years or older in substance use disorder treatment health care facilities across the US between January 1, 2015, and January 31, 2025. Urine drug test results were aggregated to generate monthly positivity rates and mean creatinine-normalized levels of fentanyl and methamphetamine (among the sample testing positive for fentanyl). Monthly, national drug overdose mortality counts were obtained from the Centers for Disease Control and Prevention.</p><p><strong>Exposures: </strong>Urine drug testing.</p><p><strong>Main outcomes and measures: </strong>Drug overdose death totals were estimated for every 6-month period from January to June 2019 through August 2024 to January 2025 by training generalized linear models with a negative binomial distribution on the preceding 4 years of data and using monthly UDT data to generate overdose estimates for the 6-month lag window of interest. Mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean squared error (RMSE) were calculated by comparing projected monthly estimates with observed overdose death totals.</p><p><strong>Results: </strong>A total of 3 135 748 UDT specimens (57.2% from men; mean [SD] age, 38.1 [12.4] years) were included in this study. From 2019 to August 2024, 537 104 people died of an overdose in the US, with a substantial increase in early 2020 at the onset of the COVID-19 pandemic. The UDT modeling strategy (MAPE, 7.1%; MAE, 540.9 deaths per month; RMSE, 659.4) outperformed the baseline autoregressive integrated moving average model (MAPE, 9.0%; MAE, 704.9 deaths per month; RMSE, 1075.8) across all metrics. Furthermore, the model detected the sudden increase in overdose deaths at the start of the COVID-19 pandemic.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, findings suggested that aggregated UDT data may be used to estimate up-to-date overdose death trends. Model implementation can be improved by introducing additional exposure variables, such as those related to drug seizures and syndromic surveillance.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514402"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247934","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":"Parental Firearm Storage and Their Teens' Perceived Firearm Access in US Households.","authors":"Katherine G Hastings, Patrick M Carter, Marc Zimmerman, Rebeccah Sokol","doi":"10.1001/jamanetworkopen.2025.14443","DOIUrl":"10.1001/jamanetworkopen.2025.14443","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Firearm access increases fatal and nonfatal firearm injury risk among teens. Identifying parental firearm storage behaviors associated with teen access may inform efforts to prevent teen firearm injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the associations between parent-reported household firearm storage behaviors and teen perceived access to firearms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used national survey data of US firearm-owning parents and their teens (aged 14 to 18 years) surveyed between June and July 2020, with a response rate of 31% for parents and 21% for teens. Analyses were conducted January to May 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;The number of firearms stored in the household as (1) unlocked, (2) loaded, (3) unlocked and loaded, and (4) unlocked or loaded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Teen perceived firearm access, overall and stratified by teen gender, parental education, and urbanicity. Survey-weighted logistic regression analyses assessed the associations between the number of firearms parents reported storing in each unsecured state (unlocked and loaded, unlocked, loaded, and unlocked or loaded) and teen perceived firearm access, overall and stratified by teen gender, parental education, and urbanicity (metropolitan vs nonmetropolitan). The areas under the receiver operating characteristic curves (AUROC) were used to identify the firearm storage behaviors with the best ability to estimate teen perceived firearm access.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analyses included 487 parent-teen dyad respondents. The mean (SE) ages of parents and teens were 46.6 (0.80) and 16.0 (0.12) years, respectively. Most parent respondents were male (58.1%; 95% CI, 50.3%-65.8%) and White (73.5%; 95% CI, 66.1%-80.9%), and most teen respondents were female (55.7%; 95% CI, 47.8%-63.6%) and White (69.5%; 95% CI, 61.8%-77.2%). All 4 unsecured firearm storage behaviors were associated with greater teen perceived firearm access (odds ratio [OR], 1.27-1.44; 95% CI, 0.99-2.10), but associations disappeared after restricting to those who stored at least 1 firearm unsecured (OR, 0.99-1.18; 95% CI, 0.67-1.89). The number of firearms stored unlocked performed the best in estimating teen perceived access to firearms in US households (AUROC, 65.7; 95% CI, 61.4-70.1), regardless of teen gender, parental education, and urbanicity. However, sensitivity of this measure was universally low (range, 42%-64%). Additionally, 36.3% (95% CI, 23.6%-49.0%) of teens reported access to a firearm in households where all firearms were stored locked and unloaded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study found that parent-reported firearm storage may be a poor estimator of teen perceived firearm access, regardless of teen gender, parental education, and urbanicity. Strictly focusing safety efforts on locked and unloaded firearm storage may not fu","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514443"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258079","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":"Outcomes of Endovascular Treatment in Patients With Vertebrobasilar Artery Occlusion Beyond 24 Hours.","authors":"Shuai Liu, Yongbo Xu, Thanh N Nguyen, Feng Gao, Yuanyuan Xue, Shuling Liu, Sifei Wang, Bohao Zhang, Leilei Luo, Xuanye Yue, Binge Chang, Hong Li, Guodong Xu, Pinyuan Zhang, Yongchang Liu, Yibin Cao, Wanchao Shi, Shouchun Wang, Lile Zhao, Xiaoguang Tong, Ming Wei","doi":"10.1001/jamanetworkopen.2025.15526","DOIUrl":"10.1001/jamanetworkopen.2025.15526","url":null,"abstract":"<p><strong>Importance: </strong>The efficacy and safety of endovascular thrombectomy (EVT) plus best medical treatment (BMT) for vertebrobasilar artery occlusion beyond 24 hours remain uncertain.</p><p><strong>Objective: </strong>To evaluate outcomes associated with EVT in patients treated beyond 24 hours after last known well time due to vertebrobasilar artery occlusion.</p><p><strong>Design, setting, and participants: </strong>This multicenter, prospective cohort study enrolled patients between 2019 and 2024 from 11 comprehensive stroke centers across China. Eligible patients with vertebrobasilar artery occlusions treated beyond 24 hours after the estimated onset were included.</p><p><strong>Exposures: </strong>Patients were categorized into 2 groups: those who underwent EVT plus BMT and those who received BMT alone.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was good functional status (modified Rankin Scale score, 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage within 24 hours and 90-day mortality.</p><p><strong>Results: </strong>Among 202 patients with vertebrobasilar occlusion (158 male [78.2%]; median [IQR] age, 64.0 [56.2-70.0] years), 101 patients received EVT plus BMT and 101 patients received only BMT. The median (IQR) posterior circulation Acute Stroke Prognosis Early Computed Tomography Score was 8 (8-9), and the median (IQR) of time of onset to admission was 48 (24-96) hours. In the primary analysis using propensity score matching, 71 patients with EVT plus BMT had a higher rate of a good functional outcome at 90 days compared with 71 patients receiving BMT alone (41 patients [57.7%] vs 32 patients [45.1%]; adjusted risk ratio [aRR], 1.35 [95% CI, 1.02-1.79]). EVT plus BMT compared with BMT alone showed lower mortality (9 patients [12.7%] vs 20 patients [28.2%]; aRR, 0.27 [95% CI, 0.08-0.81]); differences in rates of symptomatic intracranial hemorrhage were not statistically significant (4 patients [5.6%] vs 0 patients; P = .13). A similar advantage in functional outcome for EVT plus BMT (aRR, 1.33 [95% CI, 1.04-1.71]) was observed in the inverse probability of treatment weighting analysis.</p><p><strong>Conclusions and relevance: </strong>In this study, EVT plus BMT was associated with improved functional outcomes and survival rates at 90 days and a nonsignificant but numerically higher frequency of symptomatic intracranial hemorrhage than BMT alone in patients treated beyond 24 hours after last known well time. These findings suggest that randomized clinical trials comparing EVT with BMT in patients with acute vertebrobasilar artery occlusion are warranted.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2515526"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284400","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":"Respiratory Outcomes After Transcatheter vs Surgical Patent Ductus Arteriosus Closure in Preterm Infants.","authors":"Valerie Y Chock, Shazia Bhombal, Alexis S Davis, Meera N Sankar, Barbara T Do, Matthew M Laughon, Krisa P Van Meurs, Carl H Backes, Patrick J McNamara","doi":"10.1001/jamanetworkopen.2025.13366","DOIUrl":"10.1001/jamanetworkopen.2025.13366","url":null,"abstract":"<p><strong>Importance: </strong>Transcatheter closure of the patent ductus arteriosus (PDA) has increasingly been adopted in extremely preterm infants as a method to definitively close the PDA while avoiding the inherent risks of surgical ligation. Differences in respiratory outcomes after transcatheter closure compared with surgical ligation have not been substantiated, particularly in the context of timing of the intervention.</p><p><strong>Objective: </strong>To characterize respiratory outcomes in extremely preterm infants with PDA treated with transcatheter device closure compared with surgical ligation.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study assessed data from preterm infants born at less than 29 weeks' gestation or with birth weight less than 1000 g who underwent definitive PDA closure in neonatal intensive care units participating in the Neonatal Research Network's Generic Database between January 1, 2016, and December 31, 2020. Data were analyzed from October 2021 to February 2024.</p><p><strong>Exposures: </strong>PDA treatment with transcatheter device closure or with surgical ligation.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was total days of mechanical ventilation.</p><p><strong>Results: </strong>Of 3806 included infants with a PDA diagnosis, 202 underwent transcatheter PDA closure (median [IQR] gestational age, 25.4 [24.1-27.1] weeks; 114 [56%] female) and 359 underwent surgical ligation (median [IQR] gestational age, 24.9 [24.0-25.9] weeks; 187 [52%] female). Infant age at transcatheter closure was older than at surgical ligation (mean [SD], 58.7 [28.4] vs 33.6 [16.7] days; P < .001). After adjustment of analyses for center, birth year, gestational age, age at PDA intervention, and prior pharmacologic treatment, infants with transcatheter closure compared with surgical ligation had comparable respiratory outcomes, including total days of mechanical ventilation (adjusted median difference, -2.65 [95% CI, -8.36 to 3.07] days; P = .36).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of extremely preterm infants who underwent transcatheter closure compared with surgical ligation for treatment of PDA, respiratory outcomes did not differ, although the transcatheter closure group had a longer duration of PDA exposure. Future research evaluating outcomes after transcatheter PDA closure should assess the optimal timing of definitive intervention.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2513366"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208592","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":"Understanding Hospitals as Sites of Care That Address Social Needs-Why It Matters.","authors":"Monica R McLemore","doi":"10.1001/jamanetworkopen.2025.12402","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.12402","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2512402"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234142","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":"Three-Dimensional-Printed Models and Shared Decision-Making: A Cluster Randomized Clinical Trial.","authors":"Aimal Khan, Georgina E Sellyn, Danish Ali, Zorays Moazzam, Hillary Samaras, Shannon L McChesney, Michael B Hopkins, Molly M Ford, Roberta L Muldoon, Timothy M Geiger, Dann Martin, Daniel I Chu, Kyle K VanKoevering, Alexander T Hawkins","doi":"10.1001/jamanetworkopen.2025.13187","DOIUrl":"10.1001/jamanetworkopen.2025.13187","url":null,"abstract":"<p><strong>Importance: </strong>Patients undergoing surgery report a lack of involvement in health care decisions and increased anxiety. Three-dimensional (3D)-printed models serve as educational tools to encourage patient engagement, reduce anxiety levels, and aid understanding.</p><p><strong>Objective: </strong>To determine the impact of 3D-printed anatomic models on shared decision-making (SDM) and patient anxiety during the preoperative surgical consultation for colon or rectal resection.</p><p><strong>Design, setting, and participants: </strong>This single-center cluster randomized clinical trial was conducted from March 2022 to June 2023 at a colorectal surgery clinic at an academic medical institution and included adult patients scheduled for partial or complete colon and/or rectal resection for colorectal cancer, diverticular disease, or inflammatory bowel disease.</p><p><strong>Intervention: </strong>Six surgeons (clusters) were randomized to counsel patients using a modular 3D-printed model or providing usual care during preoperative clinic visits.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the patient's perception of involvement in decision-making using the 9-item Shared Decision Making Questionnaire. The secondary outcome was the change in anxiety level measured using the State-Trait Anxiety Inventory. Patient characteristics were compared between the 3D-printed model and usual care arms using a χ2 test for categorical variables and a t test for comparisons between continuous variables.</p><p><strong>Results: </strong>Among the 51 patients enrolled (mean [SD] age, 50.7 [14.5] years; 28 female [54.9%]), 28 (54.9%) were in the 3D-printed model arm and 23 (45.1%) were in the usual care arm. Patients counseled with the 3D-printed model reported a significantly higher involvement in SDM compared with those in the usual care group (mean [SD] score, 89.5 [17.6] vs 80.5 [14.4]; P = .01). Additionally, using a 3D-printed model significantly reduced mean anxiety scores (from 53.5 [SD, 21.2] to 44.1 [SD, 15.8]) compared with conventional methods (from 50.4 [SD, 18.3] to 48.0 [SD, 15.3]) (P = .04).</p><p><strong>Conclusions and relevance: </strong>This cluster randomized clinical trial found that counseling aided with 3D models during preoperative clinic visits improved SDM among patients undergoing colorectal surgery. This study highlights the potential of 3D-printed models as a tool to enhance patient-clinician collaborations. Given the findings, further research into the effectiveness and implementation of these tools is recommended in more diverse clinical settings.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06625008.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2513187"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208596","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":"Use of the 988 Suicide and Crisis Lifeline at National, Regional, and State Levels.","authors":"Jonathan Purtle, Amanda I Mauri, Sachini Bandara, Elizabeth A Stuart","doi":"10.1001/jamanetworkopen.2025.14323","DOIUrl":"10.1001/jamanetworkopen.2025.14323","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514323"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247879","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":"Social Network Exposure to Commercial Sexual Exploitation and Risk of Harm to Youths.","authors":"Ieke de Vries, Matthew Kafafian, Sheelah Gobar, Amy Farrell","doi":"10.1001/jamanetworkopen.2025.13520","DOIUrl":"10.1001/jamanetworkopen.2025.13520","url":null,"abstract":"<p><strong>Importance: </strong>Commercial sexual exploitation (CSE) of young people (aged 6-26 years) poses a considerable public health and social challenge. Understanding how social network exposure to CSE influences CSE risk may inform targeted prevention strategies for at-risk youths.</p><p><strong>Objective: </strong>To examine the association between social network exposure to CSE and personal risk of experiencing CSE among youths, with a focus on how exposure interacts with childhood adversities.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used data collected between January 1, 2015, and December 31, 2022, from a CSE program at a children's advocacy center in the northeastern US. Eligibility criteria included referral for suspected or confirmed CSE risk. Social relationships with offenders, peers, and others sharing residential placements were examined as potential sources of exposure. The final analyses were completed on March 20, 2025.</p><p><strong>Exposure: </strong>Social network exposure to CSE among youths.</p><p><strong>Main outcomes and measures: </strong>Experiencing CSE was the main outcome. Logistic regression was used to assess associations between youth network exposure to CSE and the risk of experiencing CSE, and social network analyses were conducted to identify patterns in the connections between youths with and without CSE experiences.</p><p><strong>Results: </strong>A total of 997 youth were included in the study (mean [SD] age, 14.7 [2.1] years; 903 female [90.6%]). Youths exposed to CSE through their social networks were significantly more likely to experience CSE (adjusted odds ratio, 2.92; 95% CI, 1.91-4.47). A significant interaction between social exposure and childhood adversities revealed that social network exposure was associated with higher CSE risk among youth with fewer adversities (adjusted odds ratio, 1.45; 95% CI, 1.22-1.74). Network analyses revealed that youth experiencing CSE were more likely to be connected to one another (β [SE], 0.32 [0.14]), highlighting the clustering of CSE within social networks.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that prevention strategies should aim to reduce unmitigated exposure to individuals experiencing CSE and focus on fostering supportive and healthy relationships. This study underscores the potential for social network modeling to identify at-risk youth and inform prevention efforts.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2513520"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258081","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":"Alcohol-Associated Liver Disease Mortality.","authors":"Chun-Wei Pan, Yazan Abboud, Amit Chitnis, Wei Zhang, Ashwani K Singal, Robert J Wong","doi":"10.1001/jamanetworkopen.2025.14857","DOIUrl":"10.1001/jamanetworkopen.2025.14857","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Alcohol-associated liver disease (ALD) is a major public health concern, accounting for one-quarter of cirrhosis-related deaths and becoming the leading indication for liver transplantation in the US, with concerning increases in mortality during and following the COVID-19 pandemic onset.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate comprehensive national trends in ALD mortality in the US from 1999 to 2022, with a particular focus on disparities related to sex, race, ethnicity, and age.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cross-sectional analysis used the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research mortality database from 1999 to 2022, examining death certificates across all 50 states and the District of Columbia. The study included individuals aged 25 years and older. Data analysis was performed from September to November 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;ALD mortality was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (K70.xx) for both alcohol-associated hepatitis (K70.1x) and alcohol-associated cirrhosis (K70.3x).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary outcomes included age-adjusted annual mortality rates per 100 000 population, stratified by sex, age groups (25-44, 45-64, 65-84, and ≥85 years), race and ethnicity, and geographic regions. Joinpoint regression analysis was used to calculate average annual percentage changes (AAPCs) and to identify significant trend changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study, a total of 436 814 ALD deaths were recorded (308 923 men [70.7%]), with ALD mortality increasing from 6.71 to 12.53 deaths per 100 000 between 1999 and 2022 and significant acceleration during 2018 to 2022 (annual percentage change [APC], 8.94%; 95% CI, 6.27% to 14.51%; P = .001). Women showed more rapid increases than men (AAPC, 4.29% [95% CI, 3.09% to 5.51%] vs 2.50% [95% CI, 1.51% to 3.51%]), whereas young adults (aged 25-44 years) demonstrated concerning trends (AAPC, 4.23%; 95% CI, 3.47% to 4.83%; P = .001). American Indian and Alaska Native populations experienced the highest mortality rates, increasing from 25.21 to 46.75 deaths per 100 000 (AAPC, 4.93%; 95% CI, 3.45% to 5.96%; P = .001). Alcohol-associated hepatitis mortality increased from 0.47 to 0.76 deaths per 100 000 (AAPC, 2.08%; 95% CI, 1.27% to 3.05%; P = .001), with women showing steeper increases than men (AAPC, 3.94% [95% CI, 2.58% to 5.46%] vs 1.56% [95% CI, 0.73% to 2.42%]). Alcohol-associated cirrhosis mortality increased from 4.09 to 9.52 deaths per 100 000 (AAPC, 4.00%; 95% CI, 3.63% to 4.40%; P = .001), with particularly concerning trends among women (APC from 2011 to 2022, 8.32%; 95% CI, 7.40% to 9.82%; P = .01) and adults aged 25 to 44 years (APC from 2018 to 2022, 19.51%; 95% CI, 15.00% to 28.53%; P = .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514857"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266216","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":"Outcomes for Very Preterm Infants Across Health Systems.","authors":"Jeannette A Rogowski, Lucy Greenberg, Erika M Edwards, Danielle E Y Ehret, Jeffrey S Buzas, Jeffrey D Horbar","doi":"10.1001/jamanetworkopen.2025.13274","DOIUrl":"10.1001/jamanetworkopen.2025.13274","url":null,"abstract":"<p><strong>Importance: </strong>As a result of consolidation in the health care delivery system, most very preterm infants in the US are born and receive care in multihospital health systems. The extent of variation in patient outcomes and length of stay for this vulnerable population across health systems and across hospitals within systems is not known.</p><p><strong>Objective: </strong>To evaluate the extent of variation in mortality and length of stay within and across health systems for infants born very preterm (gestational age 24-29 weeks).</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study examined data contributed by Vermont Oxford Network US member hospitals in 224 health systems that delivered care to very preterm infants born between January 1, 2021, and December 31, 2022.</p><p><strong>Exposure: </strong>Receipt of neonatal intensive care unit (NICU) care in a horizontally integrated multihospital health system.</p><p><strong>Main outcomes and measures: </strong>Mortality rates and length of stay among surviving infants were estimated using multilevel logistic and linear models.</p><p><strong>Results: </strong>The sample included 38 501 infants (median [IQR] gestational age, 27 [26-28] weeks; 52.8% boys). The median (IQR) number of infants receiving care at a hospital system during the 2-year period was 108 (59-198); 91.0% were born at the reporting hospital, and 95.4% were born in the reporting system. The mean adjusted mortality rate in the highest performing quartile of systems was 7.8% (95% credible interval [CrI], 7.3%-8.3%) compared with 9.8% (95% CrI, 9.1%-10.7%) for the lowest performing quartile. The mean adjusted length of stay for surviving infants ranged from 78 days (95% CrI, 77-79 days) to 90 days (95% CrI, 88-91 days) between the highest and lowest performing quartiles of systems, respectively.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of very preterm infants, there was a 2-percentage point difference in mortality between systems in the highest and lowest performing quartiles and a 12-day difference in mean length of stay among surviving infants, which are potentially clinically meaningful. Opportunities exist for health systems to improve quality at the health system level to decrease mortality among infants born very preterm and reduce resources used in patient care.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2513274"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199073","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}