JAMA Network Open最新文献

{"title":"Sleep Duration and Daytime Sleepiness Among Adolescents.","authors":"Lu Dong, Wendy Troxel","doi":"10.1001/jamanetworkopen.2026.38588","DOIUrl":"10.1001/jamanetworkopen.2026.38588","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638588"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169868","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":"Quality of Life After Organ Preservation in Rectal Cancer-Beyond Survival.","authors":"Chandler A Annesi, Daniel I Chu","doi":"10.1001/jamanetworkopen.2026.38973","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.38973","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638973"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194081","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":"Early Mitral Valve Surgery and Survival in Asymptomatic Severe Primary Mitral Regurgitation.","authors":"Juhee Ahn, Soongu Kwak, Jaehyun Lim, Kyu Kim, Jihoon Kim, Byung Joo Sun, Dae-Hee Kim, Kyung Hwan Kim, Chi Young Shim, Sung-Ji Park, Sungho Won, Seung-Pyo Lee","doi":"10.1001/jamanetworkopen.2026.37061","DOIUrl":"10.1001/jamanetworkopen.2026.37061","url":null,"abstract":"<p><strong>Importance: </strong>The optimal timing of mitral valve (MV) surgery in patients with asymptomatic severe primary mitral regurgitation (MR) remains uncertain because randomized clinical trials are lacking.</p><p><strong>Objective: </strong>To evaluate the association of early MV surgery with long-term survival in patients with asymptomatic severe primary MR using a target trial emulation framework.</p><p><strong>Design, setting, and participants: </strong>This cohort study used a clinical valve registry from 3 tertiary hospitals in South Korea between 2000 and 2022. Patients with asymptomatic severe primary MR were analyzed using a clone-censor-weight approach to emulate a target trial. A 6-month grace period after diagnosis was used to define treatment strategies. This analysis was conducted from September 2024 to January 2025.</p><p><strong>Exposure: </strong>Early MV surgery (within 6 months of diagnosis) vs watchful waiting.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was all-cause mortality and the secondary outcome, a composite of all-cause mortality or heart failure hospitalization. Inverse probability of censoring-weighted estimates of the per-protocol effect size included restricted mean survival time (RMST) differences as the primary measure and hazard ratios (HRs) as secondary measures.</p><p><strong>Results: </strong>Among 802 patients (mean [SD] age, 55 [16] years; 476 men [59%]), 344 underwent early surgery, and 458 received watchful waiting. During a median (IQR) follow-up of 7.4 (4.1-11.6) years, 27 deaths occurred in the early surgery group and 103 in the watchful waiting group. At 5 years, early surgery was associated with an RMST gain of 66 days (95% CI, 19-129 days). The survival benefit persisted up to 15 years. Early surgery was also associated with a lower risk of all-cause mortality compared with watchful waiting (HR, 0.69; 95% CI, 0.41-0.94; P = .02). Similar associations were observed in patients without left ventricular decompensation (HR, 0.61; 95% CI, 0.31-0.96; P = .04) and in those with degenerative MR (HR, 0.66; 95% CI, 0.36-0.98; P = .04).</p><p><strong>Conclusions and relevance: </strong>In this multicenter cohort study with a target trial framework, early surgery was associated with improved long-term survival among patients with asymptomatic severe primary MR. These findings support consideration of earlier surgical intervention in contemporary clinical practice.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637061"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109752","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":"Sexual Orientation and Gender Identity Data and HIV Preexposure Prophylaxis Disparity Detection.","authors":"Dhruv Khurana, Maryah Garner, Sonam Khurana, Bijan Sasaninia, Anthony Firek","doi":"10.1001/jamanetworkopen.2026.38995","DOIUrl":"10.1001/jamanetworkopen.2026.38995","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;US federal reporting changes in 2025 removed sexual orientation and gender identity (SOGI) measures from health-center reporting, raising concerns about equity surveillance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To quantify how incomplete or absent SOGI data are associated with detection of disparities in documented HIV preexposure prophylaxis (PrEP) orders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used electronic health record data from a large safety-net health system in Southern California. Data were from patients 18 years or older registered as of October 28, 2025, with documented PrEP orders from January 2, 2019, through October 27, 2025. Registration dates were unavailable, precluding common follow-up. Three surveillance scenarios were assessed: complete SOGI, sex assigned at birth (SAAB) only, and joint SOGI missingness from 0% to 90%. Adults with classifiable SAAB, sexual orientation, and gender identity were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Complete, unavailable, or partially missing SOGI data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was any documented PrEP order. Logistic regression models adjusted for age and race and ethnicity, with interactions of sexual orientation or gender identity with SAAB. Marginally standardized probabilities and adjusted percentage-point differences were estimated within SAAB strata. Each nonzero missing level included 250 simulations to assess the magnitude, precision, and statistical detectability of each difference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 165 198 adults (mean [SD] age, 45.0 [16.4] years). Most patients (97 621 [59.1%]) were female SAAB; 5790 (3.5%) were lesbian, gay, bisexual, or another sexual minority (LGB+) and 303 (0.2%) were transgender or gender diverse (TGD). A total of 1406 patients (0.9%) had a documented PrEP order. Under the complete SOGI analytic scenario, the adjusted probability of a documented PrEP order among cisgender patients assigned male at birth was 26.7 percentage points (pp) (95% CI, 24.9-28.5 pp; P &lt; .001) higher for LGB+ patients than for heterosexual patients. Among all patients assigned male at birth, the adjusted probability was 12.3 pp (95% CI, 7.0-17.6 pp; P &lt; .001) higher for TGD patients than for cisgender patients. Neither difference was significant among patients assigned female at birth. Under SAAB-only surveillance, only a difference between male and female SAAB was measurable (1.4 pp; 95% CI, 1.3-1.5 pp; P &lt; .001), whereas SOGI-specific differences were not estimable. Under joint missing-completely-at-random deletion, positive-direction detectability of the male-SAAB sexual orientation difference remained at 100% through 90% missingness; detectability of the gender identity difference declined from 100% at 40% missingness to 51.6% at 80% missingness and 19.2% at 90% missingness. Selective missingness attenuated estimates.&lt;/p&gt;&lt;p&gt;&lt;","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638995"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181945","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":"Public Perceptions of Timeliness for AI Use and Human Oversight.","authors":"Natalie C Benda, Uday Suresh, Afra Shamnath, Isabella Buitron, Megan E Salwei, Laurie Lovett Novak, Xuhai Xu, Meghan Reading Turchioe","doi":"10.1001/jamanetworkopen.2026.39048","DOIUrl":"10.1001/jamanetworkopen.2026.39048","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639048"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181947","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":"Wait Times for Initial Cognitive Care Appointments.","authors":"Jennifer C Knox, Yinghua Chen, Jeremy J Pruzin","doi":"10.1001/jamanetworkopen.2026.39836","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.39836","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639836"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238580","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":"Neighborhood Disadvantage and Unequal Detection of Atrial Fibrillation.","authors":"Kamala P Tamirisa, Larry R Jackson","doi":"10.1001/jamanetworkopen.2026.40205","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.40205","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640205"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244593","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":"Age at Iatrogenic Menopause and Cardiovascular Morbidity and Mortality: A Systematic Review and Meta-Analysis.","authors":"Eleni Armeni, Ipek Betul Ozcivit Erkan, Punith Kempegowda","doi":"10.1001/jamanetworkopen.2026.37545","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.37545","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Iatrogenic menopause is common, but its long-term cardiovascular consequences remain uncertain, particularly by age at menopause.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To quantify associations between iatrogenic menopause and cardiovascular morbidity and mortality and evaluate whether age at iatrogenic menopause is a modifier.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;In this systematic review and meta-analysis, Scopus, MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PsycINFO were searched from January 2004 to March 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;Observational studies and randomized clinical trials reporting cardiovascular morbidity or mortality among women with iatrogenic menopause before natural menopause age compared with naturally menopausal or age-matched controls were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;Data were extracted in duplicate by 2 independent reviewers, with consensus resolution. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary outcomes were cardiovascular morbidity, cardiovascular and all-cause mortality, and a composite of cardiovascular morbidity and cardiovascular mortality, quantified as random-effects pooled hazard ratios (PHRs) with 95% CIs, irrespective of heterogeneity and with age at menopause as a moderator. Meta-regression estimates were clustered by source cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 14 409 records, 36 studies were included with 2 617 942 women (mean [SD] age, 55.52 [12.41] years for the iatrogenic menopause cohort and 45.58 [16.02] years for comparators); median follow-up was 16.0 years (range, 4.8-36.0 years). Iatrogenic menopause vs comparators was associated with higher risk of all-cause mortality (PHR, 1.08; 95% CI, 1.01-1.16), cardiovascular events (PHR, 1.25; 95% CI, 1.12-1.39), coronary heart disease (PHR, 1.48; 95% CI, 1.07-2.03), and stroke (PHR, 1.22; 95% CI, 1.15-1.28). Mortality excesses were confined to iatrogenic menopause before age 45 years (cardiovascular mortality: PHR, 1.20 [95% CI, 1.04-1.37]; all-cause mortality: PHR, 1.15 [95% CI, 1.06-1.25]), with null estimates at or after age 45 years (cardiovascular mortality: PHR, 0.95 [95% CI, 0.81-1.11]; all-cause mortality: PHR, 0.99 [95% CI, 0.89-1.09]). In a post hoc meta-regression on the composite outcome, each increasing 5-year increment in age at iatrogenic menopause was associated with lower risk (HR, 0.89; 95% CI, 0.83-0.97) based on 37 estimates from 11 independent populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study, iatrogenic menopause was associated with higher cardiovascular morbidity, most consistently stroke, and with cardiovascular and all-cause mortality excesses before age 45 years at menopause. Older age at iatrogenic menopause was associated with progressively lower","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637545"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109629","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":"Longitudinal Metabolic Control in Children With Early-Treated Phenylketonuria.","authors":"Shunan Wang, Jinqi Zhao, Lifei Gong, Yue Tang, Lulu Li, Wan Yang, Lijin Gu, Yuanyuan Kong","doi":"10.1001/jamanetworkopen.2026.37183","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.37183","url":null,"abstract":"<p><strong>Importance: </strong>Long-term metabolic control remains difficult in phenylketonuria despite newborn screening and early treatment, and longitudinal evidence is limited, particularly in China.</p><p><strong>Objective: </strong>To describe age-associated metabolic patterns and factors associated with phenylalanine control in children with early-treated phenylketonuria.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included children with early-treated phenylketonuria identified through newborn screening and followed up through up to age 18 years in Beijing, China, from January 1998 to February 2024. Blood phenylalanine measurements from February 1998 to March 2025 were analyzed from the first normal posttreatment test until before age 18 years. Data were analyzed from October 2025 to March 2026.</p><p><strong>Exposures: </strong>Diagnosis type, family socioeconomic status (SES), and birth year.</p><p><strong>Main outcomes and measures: </strong>Outcomes of interest were longitudinal blood phenylalanine concentrations and first deterioration in annual control state. Linear mixed-effects and multistate Cox models were used.</p><p><strong>Results: </strong>Among 325 children (179 [55.1%] male; median [IQR] follow-up, 8.32 [5.41 to 12.26] years) included, 227 (69.8%) had classic phenylketonuria, and 98 (30.2%) had mild phenylketonuria. Metabolic control worsened with age: the mean (SD) phenylalanine concentration was 197 (76.7) µmol/L during the first year of life and exceeded 360 µmol/L from age 6 years onward. By age 12 years, only 17 of 78 children (21.8%) with available data remained in a good annual control state. In adjusted linear mixed-effects models, classic phenylketonuria was associated with higher square root-transformed phenylalanine concentrations than mild phenylketonuria (β = 0.82; 95% CI, 0.16 to 1.47; P = .02), whereas high SES was associated with lower concentrations (β = -2.00; 95% CI, -2.82 to -1.19; P < .001). In multistate Cox models, classic phenylketonuria was associated with a higher hazard of metabolic control worsening from good to fair control (hazard ratio [HR], 1.50; 95% CI, 1.08 to 2.09; P = .02), whereas high SES (HR, 0.54; 95% CI, 0.35 to 0.83; P = .005) and more recent birth year (HR per 5-year increase, 0.68; 95% CI, 0.61 to 0.76; P < .001) were associated with lower hazard.</p><p><strong>Conclusions and relevance: </strong>In this retrospective cohort study of children with early-treated phenylketonuria in Beijing, metabolic control worsened with age and was poorer in classic phenylketonuria than mild phenylketonuria. Higher SES and more recent birth year were associated with better control. These findings support sustained, age-specific management throughout childhood and adolescence.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637183"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109755","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":"Hospital Cesarean Delivery Rankings by Overall, Low-Risk, and Reliability-Adjusted Metrics.","authors":"Tetsuya Kawakita, Regan N Theiler, George Saade","doi":"10.1001/jamanetworkopen.2026.37167","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.37167","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The Society for Maternal-Fetal Medicine (SMFM) low-risk cesarean delivery metric aims to improve comparability, but the extent to which additional patient-level adjustment and reliability profiling alter hospital rankings is not well characterized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate how hospital cesarean delivery rankings differ across overall, SMFM-defined low-risk, and reliability-adjusted low-risk approaches, and to identify hospital characteristics associated with reliability-adjusted low-risk rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used data from the 2022 National Inpatient Sample, a nationally representative all-payer database, on individuals aged 11 to 55 years who were hospitalized for childbirth. Data were analyzed from October 2025 through June 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Hospital cesarean delivery rates and rankings based on overall births, SMFM low-risk births (unadjusted), and empirical bayesian reliability-adjusted SMFM low-risk rates (mixed-effects logistic regression adjusting for age and obstetric comorbidities). Concordance was summarized by quartile cross-classification. Hospitals were classified as as-expected, lower-than-expected, or higher-than-expected on the basis of the 95% credible interval for the reliability-adjusted rate relative to the overall mean, and a hospital-level multivariable regression assessed characteristics associated with that rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 330 977 SMFM low-risk deliveries (mean [SD] maternal age, 29.0 [5.7] years) across 1231 hospitals, 45 471 (13.7%) were cesarean. Mean (SD) hospital cesarean delivery rates were 32.1% (5.4%) for overall cesarean delivery, 13.5% (4.2%) for SMFM low-risk cesarean delivery, and 10.4% (2.4%) for reliability-adjusted SMFM low-risk cesarean delivery. Quartile concordance between overall and unadjusted SMFM low-risk rankings was modest (61.7% agreement in the lowest quartile), whereas concordance between SMFM low-risk and reliability-adjusted rankings was higher (85.7% agreement in the lowest quartile). Based on 95% credible intervals, 1024 hospitals (83.2%) were classified as having as-expected rates of cesarean delivery, 81 (6.6%) as having lower-than-expected rates of cesarean delivery, and 126 (10.2%) as having higher-than-expected rates of cesarean delivery. In multivariable analysis, Midwestern (β = -1.13 percentage points; 95% CI, -1.56 to -0.70 percentage points) and Western (β = -1.26 percentage points; 95% CI, -1.68 to -0.83 percentage points) hospitals had lower reliability-adjusted rates than Northeastern hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study of US hospitals, cesarean delivery rankings differed substantially between overall and SMFM low-risk denominators, highlighting limitations of overall rates for accountability. The high concordance between unadjusted and","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637167"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109791","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}