JAMA Network Open最新文献

{"title":"Moving the Dial on Unnecessary Preoperative Testing.","authors":"Clifford C Sheckter","doi":"10.1001/jamanetworkopen.2025.35756","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.35756","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535756"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232685","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":"Error in Table.","authors":"","doi":"10.1001/jamanetworkopen.2025.40119","DOIUrl":"10.1001/jamanetworkopen.2025.40119","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2540119"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199544","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 Health Response to the First Locally Acquired Malaria Outbreaks in the US in 20 Years.","authors":"Timothy N DeVita, Andrea M Morrison, Danielle Stanek, Michael Drennon, Elizabeth Sarney, Wade Brennan, Kelly Tomson, Carina Blackmore, Kelly Broussard, Monique Duwell, David Blythe, Laura Rothfeldt, Theresa Dulski, Keith Blount, Savanna Ledford, Dawn Blackburn, Erika Wallender, Joel L N Barratt, Brian H Raphael, Audrey E Lenhart, Alison D Ridpath, Kimberly E Mace, Seymour G Williams, Charles B Beard, Monica E Parise, Peter D McElroy","doi":"10.1001/jamanetworkopen.2025.35719","DOIUrl":"10.1001/jamanetworkopen.2025.35719","url":null,"abstract":"<p><strong>Importance: </strong>In 2023, the US reported 10 locally acquired mosquito-transmitted malaria cases of 4 genetic lineages in 4 states, the first such outbreaks detected in 20 years and the largest in 35 years.</p><p><strong>Objective: </strong>To present the investigations, interventions, and challenges in the public health response to the malaria outbreaks and provide recommendations for future outbreaks.</p><p><strong>Design, setting, and participants: </strong>This qualitative study was an interdisciplinary public health response to the locally acquired malaria outbreaks in May to December 2023 and included case investigations, enhanced case finding, polymerase chain reaction analysis of captured Anopheles spp mosquitoes for Plasmodium spp parasites, and novel targeted amplicon sequencing of Plasmodium spp in patient blood samples. Public health interventions included incident command activation, clinician outreach, community awareness, and vector control. Patient data were acquired through public health surveillance as part of National Notifiable Disease Surveillance.</p><p><strong>Exposure: </strong>Plasmodium vivax-infected and Plasmodium falciparum-infected Anopheles spp mosquitoes.</p><p><strong>Main outcomes and measures: </strong>Confirmed malaria infection via blood film microscopy and polymerase chain reaction, presence of Plasmodium spp in Anopheles spp mosquitoes, and genetic markers associated with an endemic region of origin and parasite strain relatedness via targeted amplicon sequencing.</p><p><strong>Results: </strong>The study included 10 patients (mean [SD] age of 39.5 [15.0] years; 7 male [70%]) from Florida, Texas, Maryland, and Arkansas with locally acquired mosquito-transmitted malaria and 783 Anopheles spp mosquitoes across 4 states. No patient had a recent history of international travel or blood-borne exposures. Outbreak cases had epidemiologic links within but not across state lines. P vivax was detected in 3 Anopheles crucians in Florida. Sequencing data showed that all Florida P vivax cases shared the same Plasmodium strain. The Texas and Arkansas P vivax cases were genetically distinct from each other and from Florida's cases. All 9 P vivax strains had genetic signatures that were consistent with Central and South American origin. Maryland's P falciparum parasites were consistent with African origin. The outbreaks were contained.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study of locally transmitted malaria, outbreaks remained contained to individual counties, with Florida's P vivax cases linked to a single strain distinct from those in other states. Sustained Plasmodium spp transmission is unlikely in the US, though increases in global travel and migration, population, temperatures, and persistence of Anopheles spp vectors may increase risk for locally acquired malaria. Clinicians should prescribe chemoprophylaxis for patients traveling to endemic regions, ensure timely diag","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535719"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232633","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":"A Surgical Handover System for Patient Physiology and Safety.","authors":"Jessica M Ryan, Therese M Lynn, Dara O Kavanagh, Jan Sorensen, Anastasija Simiceva, Walter Eppich, Barry O'Sullivan, Alexandra Zaborowski, Tom V McIntyre, Gerard F Curley, Bridget Egan, Saoirse Morrin, XinYi Low, Joel Rajesh, Frank Crossen, David Hearne, Alexandra Troy, Sri Qistina Emily Mohammad Feisal, Caelan Mulligan, Laura Labbe, Angelyn Chow Pui Shan, Ian S Reynolds, Helen Earley, Deborah A McNamara","doi":"10.1001/jamanetworkopen.2025.38896","DOIUrl":"10.1001/jamanetworkopen.2025.38896","url":null,"abstract":"<p><strong>Importance: </strong>Ineffective patient handover leads to patient harm, yet no criterion standard exists for safe and effective practice in surgery.</p><p><strong>Objective: </strong>To determine whether the SIPS (sickest patients first; introduction, situation, background, assessment, recommendation; prioritize; summarize) surgical handover system is associated with improved patient physiology and safety.</p><p><strong>Design, setting, and participants: </strong>This prospective interventional cohort study included an effectiveness-implementation hybrid design and was carried out between January 2023 and June 2024 at the general surgery departments of 2 tertiary academic hospitals. Physicians participating in postcall (emergency) general surgery handover meetings were included. Data were collected for consecutive patients admitted for emergency general surgery before and after implementation of the intervention, providing they had a minimum of 6 hours of Early Warning Score data available following the time of the handover meeting. Data were analyzed from November 27, 2023, to May, 8, 2025.</p><p><strong>Exposure: </strong>Staff were trained in the use of a 4-step approach to handover meetings, SIPS, which defines the minimum steps required for safe surgical handover.</p><p><strong>Main outcomes and measures: </strong>Handover quality, changes in vital signs, length of stay, mortality, escalations in care, staff perceptions of safety, and implementation success were evaluated through handover observations, a retrospective review of patient records, and staff surveys.</p><p><strong>Results: </strong>Data were collected for 2261 patients, including 1469 patients before the intervention (708 [48.2%] female; mean [SD] age 54.6 [20.3] years) and 792 patients after the intervention (411 [51.9%] female; mean [SD] age 52.8 [20.6] years). A total of 182 residents took part in handovers during the study period, during which time 126 handover meetings were observed. After the intervention, handover quality improved across multiple domains without prolonging meeting duration and was associated with significant improvements in patient vital signs at 12 hours (170 patients [21.5%] vs 247 patients [16.8%]; difference, 4.6 [95% CI, 1.2 to 8.1] percentage points; P = .007) and 24 hours (212 patients [26.8%] vs 294 patients [20.0%]; difference, 6.7 [95% CI, 3.0 to 10.4] percentage points; P < .001). Staff-reported handover-related patient safety events also decreased after the intervention (13 days with events [19.7%] vs 4 days with events [4.6%]; difference, -15.1 [95% CI -4.5 to -25.6] percentage points; P = .004), with improvements in staff-perceived handover safety and quality. Successful implementation was confirmed by high rates of adoption, fidelity, and sustainability.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, implementation of the SIPS surgical handover system was associated with improvements in handover quality,","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2538896"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232703","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":"Comparative Clinical Outcomes of Nusinersen and Gene Therapy in Spinal Muscular Atrophy Type 1.","authors":"Juliette Ropars, Claude Cances, Rocio Garcia-Uzquiano, Marta Gomez-Garcia de la Banda, Christine Barnerias, Frédérique Audic, Julien Durigneux, Cécile Halbert, Lionelle Nkam, Vincent Laugel, Caroline Espil, Ulrike Walther-Louvier, Jean-Baptiste Davion, Arnaud Isapof, Laure Le Goff, Isabelle Desguerre, Susana Quijano-Roy, Lamiae Grimaldi","doi":"10.1001/jamanetworkopen.2025.36348","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36348","url":null,"abstract":"<p><strong>Importance: </strong>Therapeutic advances have transformed the prognosis of spinal muscular atrophy (SMA). Given the lifelong implications of these innovative therapies, comparative data on their efficacy are urgently required.</p><p><strong>Objective: </strong>To compare clinical outcomes of nusinersen and onasemnogene abeparvovec gene therapy as first-line treatments in children with SMA type 1 (SMA1).</p><p><strong>Design, setting, and participants: </strong>This comparative effectiveness study used data from the French National SMA Registry from September 2016 to July 2024. The follow-up period started at treatment initiation and continued until July 22, 2024, or death. Children with genetically confirmed SMA1 (types a, b, or c) treated within 6 months of diagnosis with either nusinersen or gene therapy as first-line therapy and followed up for at least 24 months were included. Matching criteria included age, baseline score on the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders, and respiratory and nutritional status at treatment initiation.</p><p><strong>Exposure: </strong>First-line treatment with either nusinersen or gene therapy.</p><p><strong>Main outcomes and measures: </strong>Outcomes included respiratory and nutritional support needs, motor function, and unsatisfactory clinical response (UCR)- a composite of death, treatment switch (or, for gene therapy, addition) due to inadequate response, initiation of feeding support, and/or failure to achieve independent sitting.</p><p><strong>Results: </strong>Among 1366 patients enrolled in the registry, 309 were diagnosed with SMA1. Twenty-four children in 12 matched pairs met inclusion criteria (14 [58%] male; mean [SD] age at treatment initiation, 6.1 [3.0] months [range, 2.3-11.9 months]). Three patients (1 receiving gene therapy [8%], 2 receiving nusinersen [17%]) died within the first year of treatment. At 2 years posttreatment, 1 of the 11 surviving patients treated with gene therapy (9%) required nutritional support vs 5 of 10 (50%) treated with nusinersen, and nocturnal ventilation was required in 5 of 11 (45%) receiving gene therapy vs 8 of 10 (80%) receiving nusinersen. Motor outcomes were comparable between groups (mean [SE] intrapair difference in CHOP-INTEND score evolution, -1.69 [1.24] points; P = .17). UCR occurred in 8 of 12 patients (67%) receiving nusinersen and 3 of 12 (25%) receiving gene therapy.</p><p><strong>Conclusions and relevance: </strong>In this comparative effectiveness study of children with SMA1, gene therapy was associated with lower incidence of UCR and fewer supportive care needs vs nusinersen. These exploratory findings warrant confirmation in larger studies.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536348"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251003","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":"Targeting Social Function With Memantine in Autism Spectrum Disorder-Evidence for Precision Treatment.","authors":"Daniel Felsky","doi":"10.1001/jamanetworkopen.2025.34938","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.34938","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534938"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199529","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":"Use of Ambient AI Scribes to Reduce Administrative Burden and Professional Burnout.","authors":"Kristine D Olson, Daniella Meeker, Matt Troup, Timothy D Barker, Vinh H Nguyen, Jennifer B Manders, Cheryl D Stults, Veena G Jones, Sachin D Shah, Tina Shah, Lee H Schwamm","doi":"10.1001/jamanetworkopen.2025.34976","DOIUrl":"10.1001/jamanetworkopen.2025.34976","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;While in short supply and high demand, ambulatory care clinicians spend more time on administrative tasks and documentation in the electronic health record than on direct patient care, which has been associated with burnout, intention to leave, and reduced quality of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine whether ambient AI scribes are associated with reducing clinician administrative burden and burnout.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This quality improvement study used preintervention and 30-day postintervention surveys to evaluate the use of the same ambient AI platform for clinical note documentation among ambulatory care physicians and advanced practice practitioners of 6 academic and community-based health care systems across the US. Clinicians were recruited by the health systems' digital health leaders; participation was voluntary. The study was conducted between February 1 and October 31, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Use of an ambient AI scribe for 30 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was change in self-reported burnout, estimated using hierarchical logistic regression. Secondary outcomes of burnout evaluated were changes in note-related cognitive task load, focused attention on patients, patient understandability of notes, ability to add patients to the clinic schedule if urgently needed, and time spent documenting after hours. Outcome measures were linearly transformed to 10-point scales to ease interpretation and comparison. Differences between preintervention and postintervention scores were determined using paired t tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 451 clinicians enrolled, 272 completed the preintervention and postintervention surveys (60.3% completion rate), and 263 with direct patient care in ambulatory clinics (mean [SD] years in practice, 15.1 [9.3]; 141 female [53.6%]) were included in the analysis. The sample included 131 primary care practitioners (49.7%), 232 attending physicians (88.2%), and 168 academic faculty (63.9%). After 30 days with the ambient AI scribe, the proportion of participants experiencing burnout decreased significantly from 51.9% to 38.8% (odds ratio, 0.26; 95% CI, 0.13-0.54). On 10-point scales, the ambient AI scribe was associated with significant improvements in secondary outcomes of burnout (mean [SE] difference, 0.47 [0.12] points), note-related cognitive task load (mean [SE] difference, 2.64 [0.13] points), ability to provide undivided attention (mean [SE] difference, 2.05 [0.18] points), patient understandability of their care plans from reading the notes (mean [SE] difference, -0.44 [0.17] points), ability to add patients to the clinic schedule if urgently needed (mean [SE] difference, 0.51 [0.24] points), and time spent documenting after hours (mean [SE] difference, 0.90 [0.19] hours).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This multicenter quality impr","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534976"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206449","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":"Unrecognized Motor Difficulties and Developmental Coordination Disorder in Preschool Children.","authors":"Barbara Scheiber, Claudia Spiegl, Jasmin Plattner, Sarah Mildner, Peter Federolf","doi":"10.1001/jamanetworkopen.2025.36227","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36227","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536227"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238874","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":"Clinical Significance of a Multicancer Screening Trial With Stage-Based End Points.","authors":"Kemal Caglar Gogebakan, Jane Lange, Lukas Owens, Amalie Pinderup, Roman Gulati, Larry G Kessler, Georgios Lyratzopoulos, Ruth Etzioni","doi":"10.1001/jamanetworkopen.2025.36247","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36247","url":null,"abstract":"<p><strong>Importance: </strong>The first randomized screening trial of a multicancer early detection test is ongoing, with the primary end point being the incidence of late-stage cancer. The unprecedented use of a stage-based end point and short 3-year follow-up raise questions about how results should be interpreted and used in developing multicancer screening policy.</p><p><strong>Objective: </strong>To estimate outcomes of the trial and to identify information from the estimates that may aid in interpreting results of short-term trials evaluating multicancer screening tests.</p><p><strong>Design, setting, and participants: </strong>This multicancer decision-analytic model estimated outcomes from registry data from the England National Cancer Registration and Analysis Service for cases diagnosed between January 2013 and December 2018. This model simulated a population-based multicancer screening trial of average-risk participants without a prior cancer diagnosis. The analysis was performed between April 2024 and April 2025.</p><p><strong>Interventions: </strong>Three annual multicancer screenings at months 0, 12, and 24. Cancers were assumed detectable 1 or 2 years before clinical diagnosis based on a published analysis, and cancer-specific early-stage sensitivities were set to either 100% or 50% of published sensitivities among clinically diagnosed cases.</p><p><strong>Main outcomes and measures: </strong>Reductions in late-stage (stage III-IV) cancer incidence over 3 years, cancer mortality over 5 years, and contributions of each cancer type to reductions in late-stage incidence and cancer mortality across the range of detectable intervals and early-stage sensitivities.</p><p><strong>Results: </strong>The model simulated 70 000 participants per arm (screening and control; median age, 66 years), and estimated that the overall late-stage incidence reductions at 3 years ranged from 6% to 23%, with corresponding reductions in 5-year cancer mortality from 6% to 9%. Colorectal cancer contributed the most to the reduction in late-stage incidence (28% to 39%), while lung cancer contributed the most to mortality reduction (40% to 42%).</p><p><strong>Conclusions and relevance: </strong>This independent decision-analytic model study found that the trial could achieve nontrivial cancer downstaging over 3 years, but modest mortality reduction over 5 years. These results were due to a limited number of target cancer types, underscoring the importance of transparent reporting of outcomes by cancer type, consideration of mortality implications, and careful preplanning for subsequent evaluation steps by the cancer research community.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536247"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251015","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":"Lung Cancer Incidence After September 11, 2001, Among World Trade Center Responders.","authors":"Sean A P Clouston, Jaymie Meliker, Frank D Mann, Pei-Fen Kuan, Yuan Yang, F Mehejabin Trina, Laura Sampson, Paolo Boffetta, Norman H Edelman, Benjamin J Luft","doi":"10.1001/jamanetworkopen.2025.36655","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36655","url":null,"abstract":"<p><strong>Importance: </strong>Responders involved in rescue and recovery operations after the collapse of the World Trade Center (WTC) on September 11, 2001, were exposed to airborne carcinogens.</p><p><strong>Objectives: </strong>To examine the incidence of lung cancer after the WTC attacks and to compare the incidence of lung cancer among responders with varying degrees of exposure severity.</p><p><strong>Design, setting, and participants: </strong>In this prospective cohort study, data were collected between July 1, 2012, and December 31, 2023, from individuals who were enrolled in a medical monitoring program available to WTC responders residing on Long Island, New York. This study was restricted to people who survived and were followed up for incident lung cancer after a 10-year latency period.</p><p><strong>Exposures: </strong>Types and durations of exposures were based on responses to a detailed questionnaire about on-site work conditions, which included information about the type and duration of work, smells, and sights while working; exposure to dust; and the use of protective equipment. World Trade Center exposure characteristics and overall severity were measured as mild, moderate, and severe exposure using a validated approach.</p><p><strong>Main outcomes and measures: </strong>The incidence of lung cancer was the primary outcome. Diagnosis of lung cancer was ascertained following a standardized approach by trained clinicians, and diagnoses were verified by clinicians at the Centers for Disease Control and Prevention. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios.</p><p><strong>Result: </strong>Among 12 334 eligible responders (mean [SD] age at study inclusion, 49.3 [10.2] years; 11 213 men [90.9%]), 118 incident lung cancers were identified between July 1, 2012, and December 31, 2023 (incidence rate, 8.7/10 000 person-years [95% CI, 7.3-10.5 person-years]). When compared with mild exposures, the incidence of lung cancer was higher among moderately (adjusted hazard ratio [AHR], 1.86 [95% CI, 1.19-2.91]; P = .007) and severely (AHR, 2.90 [95% CI, 1.69-4.99]; P < .001) exposed groups. Specific WTC exposures, including smelling fumes (AHR, 1.05 [95% CI, 1.01-1.09]; P = .007) or sewage (AHR, 1.03 [95% CI, 1.01-1.05]; P = .004), were also associated with higher incidence of lung cancer after adjusting for demographics and measures of tobacco use.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of WTC responders, the incidence of lung cancer was higher among those with greater exposure severity. Future studies may investigate specific WTC exposures and histologic changes and clarify the role of WTC exposure for prognosis.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536655"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251029","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}