JAMA Network Open最新文献

{"title":"Racial and Ethnic Differences in Prostate Cancer Epidemiology Across Disease States in the VA.","authors":"Shannon R Stock, Michael T Burns, Justin Waller, Amanda M De Hoedt, Joshua A Parrish, Sameer Ghate, Jeri Kim, Irene M Shui, Stephen J Freedland","doi":"10.1001/jamanetworkopen.2024.45505","DOIUrl":"10.1001/jamanetworkopen.2024.45505","url":null,"abstract":"<p><strong>Importance: </strong>Prostate cancer (PC) care has evolved rapidly as a result of changes in prostate-specific antigen testing, novel imaging, and newer treatments. The impact of these changes on PC epidemiology and racial disparities across disease states remains underexplored.</p><p><strong>Objective: </strong>To characterize racial and ethnic differences in the epidemiology of PC states, including nonmetastatic hormone-sensitive PC (nmHSPC), metastatic HSPC (mHSPC), nonmetastatic castration-resistant PC (nmCRPC), and metastatic CRPC (mCRPC).</p><p><strong>Design, setting, and participants: </strong>This is a retrospective, population-based cohort study of male US veterans aged 40 years and older with known race and ethnicity and no non-PC malignant neoplasm before study entry receiving care through the Veterans Health Administration. The study period was from 2012 to 2020, with follow-up through 2021. To identify active users, data capture included visits 18 months before and after the study period. Data analysis was performed from March to August 2023.</p><p><strong>Exposure: </strong>Self-identified race and ethnicity, classified as Black, White, or Hispanic.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were annual age-adjusted incidence rates (IRs) and point prevalence for PC states by race and ethnicity. Trends were evaluated using joinpoint regression. Time to disease progression or death was estimated using nonparametric cumulative incidence. Competing risk models adjusted for age assessed the association of race and ethnicity on disease progression.</p><p><strong>Results: </strong>The study included 6 539 001 veterans (median [IQR] age, 65 [56-74] years), of whom 476 227 had PC (median [IQR] age, 69 [63-75] years). IRs varied by time frame and disease state. Across all states and years, the relative risk among Black vs White patients ranged from 2.09 (95% CI, 2.01-2.18; P < .001) for nmHSPC in 2012 to 4.12 (95% CI, 3.39-5.02; P < .001) for nmCRPC in 2017. In nmHSPC, hazard ratios for progression to mHSPC and nmCRPC were 1.36 (95% CI, 1.33-1.40) and 1.60 (95% CI, 1.51-1.70), respectively, for Black patients and 1.38 (95% CI, 1.31-1.45) and 1.55 (95% CI, 1.40-1.72), respectively, for Hispanic patients vs White patients. In contrast, in mCRPC, the hazard ratio for death was lower for Black (0.84; 95% CI, 0.81-0.88) and Hispanic (0.76; 95% CI, 0.69-0.83) patients compared with White patients.</p><p><strong>Conclusions and relevance: </strong>This cohort study of veterans found that Black patients had more than 2-fold higher incidence of all disease states vs White patients. Progression risk was higher for Black and Hispanic patients in early-stage disease, but lower in later disease stages. Despite equal access, Black patients disproportionately experience PC, although progression risks relative to White patients differed according to disease state.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2445505"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638691","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 Publicly Available Information About Urinary Tract Infections.","authors":"Viktoria Schmitz, Zoe Troubh, Michael Durkin, Kevin Hsueh, Katheryn Ney, Brian D Carpenter, Shinbee Waldron, Mary C Politi","doi":"10.1001/jamanetworkopen.2024.44988","DOIUrl":"10.1001/jamanetworkopen.2024.44988","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2444988"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621069","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":"State Medical Board Sanctions for Misinformation Should Be Rare.","authors":"Megan L Ranney, Lawrence O Gostin","doi":"10.1001/jamanetworkopen.2024.43878","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.43878","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2443878"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621087","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":"Academic Physician and Trainee Occupational Well-Being by Sexual and Gender Minority Status.","authors":"Carl G Streed, May Navarra, Jessica Halem, Miriam T Stewart, Susannah G Rowe","doi":"10.1001/jamanetworkopen.2024.43937","DOIUrl":"10.1001/jamanetworkopen.2024.43937","url":null,"abstract":"<p><strong>Importance: </strong>Few studies have explored the association between sexual and gender minority (SGM) status and occupational well-being among health care workers.</p><p><strong>Objectives: </strong>To assess the prevalence of burnout, professional fulfillment, intent to leave, anxiety, and depression by self-reported SGM status.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional survey study collected data from October 2019 to July 2021, from 8 academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium. The survey, including questions on SGM status, was administered to attending physicians and trainees. Statistical analyses were performed from June 1, 2023, to February 29, 2024.</p><p><strong>Exposure: </strong>SGM status was determined via self-reported sexual orientation and gender identity.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes measured were the Professional Fulfillment Index (burnout and professional fulfillment), intent to leave, and self-reported anxiety and depression using the Patient-Reported Outcomes Measurement Information System short-form 4-item measure.</p><p><strong>Results: </strong>Of 20 541 attendings and 6900 trainees, 8376 attendings and 2564 trainees responded and provided SGM status. Of these respondents, 386 attendings (4.6%) and 212 trainees (8.3%) identified as SGM. Compared with their non-SGM peers, SGM attendings had a lower prevalence of professional fulfillment (133 of 386 [34.5%] vs 3200 of 7922 [40.4%]) and a higher prevalence of burnout (181 of 382 [47.4%] vs 2791 of 7883 [35.4%]) and intent to leave (125 of 376 [33.2%] vs 2433 of 7873 [30.9%]) (all P < .001). Compared with their non-SGM peers, SGM trainees had a lower prevalence of professional fulfillment (63 of 211 [29.9%] vs 833 of 2333 [35.7%]) and a higher prevalence of burnout (108 of 211 [51.2%] vs 954 of 2332 [40.9%]) (both P < .001). After adjusting for age and race and ethnicity, SGM attendings had higher odds of burnout than their non-SGM peers (adjusted odds ratio, 1.57 [95% CI, 1.27-1.94]; P < .001). Results for burnout were similar among the SGM trainees compared with their non-SGM peers (adjusted odds ratio, 1.47 [1.10-1.96]; P = .01).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional survey study of academic physicians and trainees, SGM attendings and trainees had higher levels of burnout and lower levels of professional fulfillment. SGM attendings had greater intent to leave than their non-SGM peers, but trainees did not. These disparities represent an opportunity for further exploration to retain SGM health care workers.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2443937"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620913","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":"Disaggregated Cancer Research and Intervention for Asian American and Pacific Islander Populations.","authors":"Edward Christopher Dee","doi":"10.1001/jamanetworkopen.2024.42419","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.42419","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2442419"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568744","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":"State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved.","authors":"Craig D Newgard, Amber Lin, Jeremy D Goldhaber-Fiebert, Katherine E Remick, Marianne Gausche-Hill, Randall S Burd, Susan Malveau, Jennifer N B Cook, Peter C Jenkins, Stefanie G Ames, N Clay Mann, Nina E Glass, Hilary A Hewes, Mary Fallat, Apoorva Salvi, Brendan G Carr, K John McConnell, Caroline Q Stephens, Rachel Ford, Marc A Auerbach, Sean Babcock, Nathan Kuppermann","doi":"10.1001/jamanetworkopen.2024.42154","DOIUrl":"10.1001/jamanetworkopen.2024.42154","url":null,"abstract":"<p><strong>Importance: </strong>High emergency department (ED) pediatric readiness is associated with improved survival among children receiving emergency care, but state and national costs to reach high ED readiness and the resulting number of lives that may be saved are unknown.</p><p><strong>Objective: </strong>To estimate the state and national annual costs of raising all EDs to high pediatric readiness and the resulting number of pediatric lives that may be saved each year.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from EDs in 50 US states and the District of Columbia from 2012 through 2022. Eligible children were ages 0 to 17 years receiving emergency services in US EDs and requiring admission, transfer to another hospital for admission, or dying in the ED (collectively termed at-risk children). Data were analyzed from October 2023 to May 2024.</p><p><strong>Exposure: </strong>EDs considered to have high readiness, with a weighted pediatric readiness score of 88 or above (range 0 to 100, with higher numbers representing higher readiness).</p><p><strong>Main outcomes and measures: </strong>Annual hospital expenditures to reach high ED readiness from current levels and the resulting number of pediatric lives that may be saved through universal high ED readiness.</p><p><strong>Results: </strong>A total 842 of 4840 EDs (17.4%; range, 2.9% to 100% by state) had high pediatric readiness. The annual US cost for all EDs to reach high pediatric readiness from current levels was $207 335 302 (95% CI, $188 401 692-$226 268 912), ranging from $0 to $11.84 per child by state. Of the 7619 child deaths occurring annually after presentation, 2143 (28.1%; 95% CI, 678-3608) were preventable through universal high ED pediatric readiness, with population-adjusted state estimates ranging from 0 to 69 pediatric lives per year.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, raising all EDs to high pediatric readiness was estimated to prevent more than one-quarter of deaths among children receiving emergency services, with modest financial investment. State and national policies that raise ED pediatric readiness may save thousands of children's lives each year.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2442154"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Related Prescription Drug Rationing by Adults With Obesity.","authors":"Alissa S Chen, Caroline G Borden, Maureen E Canavan, Joseph S Ross, Carol R Oladele, Kasia J Lipska","doi":"10.1001/jamanetworkopen.2024.33000","DOIUrl":"10.1001/jamanetworkopen.2024.33000","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2433000"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583125","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":"Clinical Variant Reclassification in Hereditary Disease Genetic Testing.","authors":"Yuya Kobayashi, Elaine Chen, Flavia M Facio, Hillery Metz, Sarah R Poll, Dan Swartzlander, Britt Johnson, Swaroop Aradhya","doi":"10.1001/jamanetworkopen.2024.44526","DOIUrl":"10.1001/jamanetworkopen.2024.44526","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Because accurate and consistent classification of DNA sequence variants is fundamental to germline genetic testing, understanding patterns of initial variant classification (VC) and subsequent reclassification from large-scale, empirical data can help improve VC methods, promote equity among race, ethnicity, and ancestry (REA) groups, and provide insights to inform clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To measure the degree to which initial VCs met certainty thresholds set by professional guidelines and quantify the rates of, the factors associated with, and the impact of reclassification among more than 2 million variants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study used clinical multigene panel and exome sequencing data from diagnostic testing for hereditary disorders, carrier screening, or preventive genetic screening from individuals for whom genetic testing was performed between January 1, 2015, and June 30, 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;DNA variants were classified into 1 of 5 categories: benign, likely benign, variant of uncertain significance (VUS), likely pathogenic, or pathogenic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The main outcomes were accuracy of classifications, rates and directions of reclassifications, evidence contributing to reclassifications, and their impact across different clinical areas and REA groups. One-way analysis of variance followed by post hoc pairwise Tukey honest significant difference tests were used to analyze differences among means, and pairwise Pearson χ2 tests with Bonferroni corrections were used to compare categorical variables among groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The cohort comprised 3 272 035 individuals (median [range] age, 44 [0-89] years; 2 240 506 female [68.47%] and 1 030 729 male [31.50%]; 216 752 Black [6.62%]; 336 414 Hispanic [10.28%]; 1 804 273 White [55.14%]). Among 2 051 736 variants observed over 8 years in this cohort, 94 453 (4.60%) were reclassified. Some variants were reclassified more than once, resulting in 105 172 total reclassification events. The majority (64 752 events [61.65%]) were changes from VUS to either likely benign, benign, likely pathogenic, or pathogenic categories. An additional 37.66% of reclassifications (39 608 events) were gains in classification certainty to terminal categories (ie, likely benign to benign and likely pathogenic to pathogenic). Only a small fraction (663 events [0.63%]) moved toward less certainty, or very rarely (61 events [0.06%]) were classification reversals. When normalized by the number of individuals tested, VUS reclassification rates were higher among specific underrepresented REA populations (Ashkenazi Jewish, Asian, Black, Hispanic, Pacific Islander, and Sephardic Jewish). Approximately one-half of VUS reclassifications (37 074 of 64 840 events [57.18%]) resulted from improved use of data from computational modeling.&lt;/p&gt;&lt;p&gt;&lt;str","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2444526"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583114","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":"Childhood Community Disadvantage and MRI-Derived Structural Brain Integrity After Age 65 Years.","authors":"Rachel L Peterson, Erika Meza, Kristen M George, Pauline Maillard, Charles DeCarli, Paola Gilsanz, Yenee Soh, Yi Lor, Amy J Kind, Lisa L Barnes, Rachel A Whitmer","doi":"10.1001/jamanetworkopen.2024.43703","DOIUrl":"10.1001/jamanetworkopen.2024.43703","url":null,"abstract":"<p><strong>Importance: </strong>Prior studies associate late-life community disadvantage with worse brain health. It is relatively unknown if childhood community disadvantage associates with late-life brain health.</p><p><strong>Objective: </strong>To test associations between childhood residence in an economically disadvantaged community, individual income and education, and late-life cortical brain volumes and white matter integrity.</p><p><strong>Design, setting, and participants: </strong>This cohort study was conducted in the ongoing harmonized cohorts KHANDLE (Kaiser Healthy Aging and Diverse Life Experiences Study; initiated 2017) and STAR (Study of Healthy Aging in African Americans; initiated 2018) using all available data collected out of a regional integrated health care delivery network in California between cohort initiation and analysis initiation in June 2023. Eligible participants were Kaiser Permanente Northern California member ages 65 years or older. Data were analyzed between June and November 2023.</p><p><strong>Exposure: </strong>Residence at birth was geocoded and linked to historical Area Deprivation Indices (ADI). ADI is a nationally ranked percentile; community disadvantage was defined as ADI of 80 or higher.</p><p><strong>Main outcomes and measures: </strong>Regional brain volumes and white matter integrity measures were derived from a random subset of participants who underwent 3T magnetic resonance imaging. Models adjusted for race and ethnicity, sex, and parental education.</p><p><strong>Results: </strong>Of a total 2161 individuals in the combined cohort, 443 individuals were eligible for imaging (mean [SD] age, 76.3 [6.5] years; 253 female [57.1%]; 56 Asian [12.6%], 212 Black [47.9%], 67 Latino [15.1%], 109 White [24.6%]). Imaging participants had a mean (SD) 15.0 (2.5) years of education, and 183 (41.3%) earned $55 000 to $99 999 annually. Fifty-four participants (12.2%) resided in a disadvantaged childhood community. Childhood community disadvantage was associated with smaller gray matter volumes overall (-0.39 cm3; 95% CI, -0.65 to -0.10 cm3) and in the cerebellum (-0.39 cm3; 95% CI, -0.66 to -0.09 cm3), hippocampus (-0.37 cm3; 95% CI, -0.68 to -0.04 cm3), and parietal cortex (-0.25 cm3; 95% CI, -0.46 to -0.04 cm3) and larger mean lateral ventricle (0.44 cm3; 95% CI, 0.12 to 0.74 cm3), third ventricle (0.28 cm3; 95% CI, 0.03 to 0.55 cm3), and white matter hyperintensity volume (0.31 cm3; 95% CI, 0.06 to 0.56 cm3). Educational attainment and late-life income did not mediate these associations.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of racially and ethnically diverse health plan members, childhood community disadvantage was associated with worse late-life brain health independent of individual socioeconomic status. Future work should explore alternative pathways (eg, cardiovascular health) that may explain observed associations.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2443703"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604489","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":"State Divorce Laws, Reproductive Care Policies, and Pregnancy-Associated Homicide Rates, 2018-2021.","authors":"Kaitlin M Boyle, Wendy Regoeczi, Chase B Meyer","doi":"10.1001/jamanetworkopen.2024.44199","DOIUrl":"10.1001/jamanetworkopen.2024.44199","url":null,"abstract":"<p><strong>Importance: </strong>Barriers to divorce and reproductive health care can threaten the health and safety of pregnant and recently pregnant females.</p><p><strong>Objective: </strong>To examine state laws about divorce, reproductive health care (access to contraception, family planning services, and abortion), and pregnancy-associated homicide rates in US states over a 4-year period (2018-2021).</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study, bivariate tests and regressions were used to analyze crude rates of pregnancy-associated homicide from the National Violent Death Reporting System in 181 state-years for calendar years 2018 to 2021, with analyses conducted on September 8, 2024.</p><p><strong>Exposures: </strong>Access to divorce while pregnant and reproductive health care over a 4-year period in the US.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes (pregnancy-associated homicide by intimate partners vs non-intimate partners and rates among younger Black, Hispanic, and White females) were assessed using the National Violent Death Reporting System. Negative binomial regression was used to test 2 hypotheses: access to divorce while pregnant and reproductive health care are associated with pregnancy-associated homicide rates.</p><p><strong>Results: </strong>Individual level data, including exact sample size, were not available in this study of state-level homicide rates. Negative binomial regression analysis showed that, where finalizing divorce during pregnancy is prohibited, intimate partner homicide rates (incidence rate ratio [IRR], 2.11; 95% CI, 1.09-4.08; P = .03) and rates among younger (age 10-24 years) White females (IRR, 2.39; 95% CI, 1.12-5.09; P = .02) were significantly higher. In state-years with greater access to reproductive health care, rates were significantly lower for non-intimate partner homicide (IRR, 0.92; 95% CI, 0.87-0.98; P = .01) and for younger Black females (IRR, 0.91; 95% CI, 0.87-0.96; P < .001) and younger Hispanic females (IRR, 0.87; 95% CI, 0.79-0.96; P = .007).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of pregnancy-associated homicide rates, barriers to divorce were associated with higher homicide rates and access to reproductive health care was associated with lower homicide rates. This study highlights the association between state legislation and pregnancy-associated homicide in the US, which is important information for policymakers.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2444199"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604519","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}