JAMA Network Open最新文献

{"title":"Presymptomatic Awareness of BRCA1/BRCA2 Status and Outcomes in Women With Ovarian Cancer.","authors":"Shunit Armon, Adi Hollander, Yakir Segev, Ora Rosengarten, Ariela Tomer, Ephrat Levy-Lahad, Rachel Michaelson-Cohen","doi":"10.1001/jamanetworkopen.2025.1435","DOIUrl":"10.1001/jamanetworkopen.2025.1435","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251435"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673929","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":"Speech Recognition Technology and Documentation Efficiency.","authors":"Abdul R Shour, Ronald Anguzu, Adedayo A Onitilo","doi":"10.1001/jamanetworkopen.2025.1526","DOIUrl":"10.1001/jamanetworkopen.2025.1526","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251526"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692144","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":"Increasing Access to Research Opportunities Among Those Who Speak Languages Other Than English.","authors":"Elizabeth A Jacobs, Monica Vela","doi":"10.1001/jamanetworkopen.2025.2387","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2387","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e252387"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728563","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":"Asymptomatic Hemorrhagic Events and Functional Outcomes in Acute Stroke: A Secondary Analysis of the DIRECT-MI Randomized Clinical Trial.","authors":"Rundong Chen, Weilong Hua, Yilei Zhang, Yongxin Zhang, Hongjian Zhang, Yongwei Zhang, Jianmin Liu, Pengfei Yang, Xiaoxi Zhang, Lei Zhang","doi":"10.1001/jamanetworkopen.2025.2411","DOIUrl":"10.1001/jamanetworkopen.2025.2411","url":null,"abstract":"<p><strong>Importance: </strong>Asymptomatic hemorrhagic infarction (HI) and subarachnoid hemorrhage (SAH) after endovascular treatment (EVT) for acute ischemic stroke are commonly considered low risk, but their long-term impact on functional outcomes is unclear.</p><p><strong>Objective: </strong>To determine whether asymptomatic HI and SAH are associated with worse 90-day functional recovery in patients with acute ischemic stroke treated with EVT.</p><p><strong>Design, setting, and participants: </strong>This is a secondary analysis of the DIRECT-MT randomized clinical trial, which compared intravenous thrombolysis prior to EVT with EVT alone. The multicenter study was conducted at tertiary hospitals in China between 2016 and 2019 with 90-day follow-up. Trial patients with asymptomatic HI, SAH, or no hemorrhage were included in the present analysis, which was performed in December 2024.</p><p><strong>Exposure: </strong>Asymptomatic HI and SAH detected on follow-up imaging.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the score on the modified Rankin scale (mRS) assessed at 90 days. Secondary analyses categorized mRS scores into thresholds of 0 to 1, 0 to 2, and 0 to 3, representing excellent, good, and favorable recovery, respectively.</p><p><strong>Results: </strong>A total of 490 patients were included (median [IQR] age, 70 [60-76] years; 210 [42.9%] female), with 133 (27.1%) in the asymptomatic HI and SAH group and 357 (72.9%) in the no hemorrhage group. After propensity score matching, the odds ratio of having a worse mRS scores at 90 days in the asymptomatic HI and SAH group compared with the no hemorrhage group was 2.59 (95% CI, 1.45-4.63; P = .001). For binary outcomes, asymptomatic HI and SAH were consistently associated with worse recovery across mRS score thresholds of 0 to 1 and 0 to 2 in all models.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of a randomized clinical trial, asymptomatic HI and SAH were associated with worse 90-day functional outcomes in patients with acute ischemic stroke treated with EVT. These findings emphasize the need for close monitoring and tailored management strategies in patients with asymptomatic hemorrhagic events following thrombectomy.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03469206.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e252411"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730153","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":"Performance of a Deep Learning Diabetic Retinopathy Algorithm in India.","authors":"Arthur Brant, Preeti Singh, Xiang Yin, Lu Yang, Jay Nayar, Divleen Jeji, Yossi Matias, Greg S Corrado, Dale R Webster, Sunny Virmani, Anchintha Meenu, Naresh Babu Kannan, Jonathan Krause, Florence Thng, Lily Peng, Yun Liu, Kasumi Widner, Kim Ramasamy","doi":"10.1001/jamanetworkopen.2025.0984","DOIUrl":"10.1001/jamanetworkopen.2025.0984","url":null,"abstract":"<p><strong>Importance: </strong>While prospective studies have investigated the accuracy of artificial intelligence (AI) for detection of diabetic retinopathy (DR) and diabetic macular edema (DME), to date, little published data exist on the clinical performance of these algorithms.</p><p><strong>Objective: </strong>To evaluate the clinical performance of an automated retinal disease assessment (ARDA) algorithm in the postdeployment setting at Aravind Eye Hospital in India.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional analysis involved an approximate 1% sample of fundus photographs from patients screened using ARDA. Images were graded via adjudication by US ophthalmologists for DR and DME, and ARDA's output was compared against the adjudicated grades at 45 sites in Southern India. Patients were randomly selected between January 1, 2019, and July 31, 2023.</p><p><strong>Main outcomes and measures: </strong>Primary analyses were the sensitivity and specificity of ARDA for severe nonproliferative DR (NPDR) or proliferative DR (PDR). Secondary analyses focused on sensitivity and specificity for sight-threatening DR (STDR) (DME or severe NPDR or PDR).</p><p><strong>Results: </strong>Among the 4537 patients with 4537 images with adjudicated grades, mean (SD) age was 55.2 (11.9) years and 2272 (50.1%) were male. Among the 3941 patients with gradable photographs, 683 (17.3%) had any DR, 146 (3.7%) had severe NPDR or PDR, 109 (2.8%) had PDR, and 398 (10.1%) had STDR. ARDA's sensitivity and specificity for severe NPDR or PDR were 97.0% (95% CI, 92.6%-99.2%) and 96.4% (95% CI, 95.7%-97.0%), respectively. Positive predictive value (PPV) was 50.7% and negative predictive value (NPV) was 99.9%. The clinically important miss rate for severe NPDR or PDR was 0% (eg, some patients with severe NPDR or PDR were interpreted as having moderate DR and referred to clinic). ARDA's sensitivity for STDR was 95.9% (95% CI, 93.0%-97.4%) and specificity was 94.9% (95% CI, 94.1%-95.7%); PPV and NPV were 67.9% and 99.5%, respectively.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study investigating the clinical performance of ARDA, sensitivity and specificity for severe NPDR and PDR exceeded 96% and caught 100% of patients with severe  NPDR and PDR for ophthalmology referral. This preliminary large-scale postmarketing report of the performance of ARDA after screening 600 000 patients in India underscores the importance of monitoring and publication an algorithm's clinical performance, consistent with recommendations by regulatory bodies.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250984"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657374","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 and Genomic Characterization of Secondary Rectal Cancer After Radiotherapy for Prostate Cancer.","authors":"Dana M Omer, Farheen Shah, Anisha Luthra, Chin-Tung Chen, Christina I Lee, Hannah Williams, Henry Walch, Floris S Verheij, Roni Rosen, Janet Alvarez, Canan Firat, Georgios Karagkounis, Martin R Weiser, Maria Widmar, Iris H Wei, Emmanouil P Pappou, Garrett M Nash, J Joshua Smith, Walid K Chatila, Paul B Romesser, Jinru Shia, Philip B Paty, Julio Garcia-Aguilar, Francisco Sanchez-Vega","doi":"10.1001/jamanetworkopen.2025.1039","DOIUrl":"10.1001/jamanetworkopen.2025.1039","url":null,"abstract":"<p><strong>Importance: </strong>Patients treated with radiotherapy (RT) for prostate cancer (PC) have increased risk of secondary rectal cancer (SRC) and more limited treatment options.</p><p><strong>Objective: </strong>To assess the tumor molecular profile, clinical characteristics, and oncologic outcomes of SRC after PC and compare them with those of primary rectal cancer (PRC).</p><p><strong>Design, setting, and participants: </strong>This case-control study included patients with SRC diagnosed 5 or more years after RT for PC and patients with PRC who were treated at Memorial Sloan Kettering Cancer Center in New York between February 1, 1994, and September 31, 2022.</p><p><strong>Main outcomes and measures: </strong>Clinical information and DNA sequencing data were analyzed. Oncologic outcomes were compared between patients with SRC and clinically matched patients with PRC using log-rank tests and Cox proportional hazards regression models. Numerical and categorical variables were compared using the Wilcoxon rank sum test and Fisher exact test, respectively.</p><p><strong>Results: </strong>The analysis included 604 male patients with PRC (71.6%; median age, 55 [IQR, 46-66] years) and 64 male patients with SRC (median age, 78 [IQR, 72-82] years). Patients with SRC had more distal rectum (37 of 63 [58.7%] vs 131 of 581 [22.5%]; P < .001) and anterior rectal wall (20 of 57 [35.1%] vs 67 of 496 [13.5%]; P < .001) tumors, were less likely to receive neoadjuvant treatment (33 of 64 [51.6%] vs 570 of 604 [94.4%]), and had shorter 5-year overall survival (45.7% vs 64.9%; P = .01) and disease-free survival (40.3% vs 71.2%; P = .006) compared with clinically matched patients with PRC. Targeted DNA sequencing data from 31 SRC tumors identified lower mutational burden (median, 4.4 [IQR, 3.2-6.7] per megabase [Mb] vs 5.8 [IQR, 4.4-7.0] per Mb; P = .047), lower frequency of APC alterations (15 [48.4%] vs 432 [79.9%]; P < .001), and higher rates of SMAD4 inactivation (8 [25.8%] vs 54 [10.0%]; P = .01) compared with 541 PRC tumors. Whole-exome sequencing data from 17 SRC tumors identified a higher rate of frameshift deletions compared with 28 PRC tumors (median, 5.0 [IQR, 4.0-9.0] vs 2.5 [IQR, 1.0-4.2] variants; P < .001).</p><p><strong>Conclusions and relevance: </strong>In this case-control study, patients with SRC after RT for PC had worse survival and different molecular profiles than patients with PRC. These findings may help improve the clinical management of SRC.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251039"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657238","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":"Preconception and Prenatal Environment and Growth Faltering Among Children in Uganda.","authors":"Paddy Ssentongo, Claudio Fronterre, Jessica E Ericson, Ming Wang, Laila Al-Shaar, Helen Greatrex, Philip O Omadi, Joseph Muvawala, Steven J Greybush, Pamela K Mbabazi, Laura E Murray-Kolb, Abraham J B Muwanguzi, Steven J Schiff","doi":"10.1001/jamanetworkopen.2025.1122","DOIUrl":"10.1001/jamanetworkopen.2025.1122","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Children with growth faltering are more susceptible to infections and may experience cognitive, physical, and metabolic developmental impairments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess whether prenatal and preconception meteorological and environmental factors are associated with village-level rates of childhood growth outcomes in Uganda.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used data collected between June 20, 2015, and December 16, 2016, from the 2016 Ugandan Demographic and Health Survey for individuals aged 0 to 59 months with available anthropometric measures (weight and length or height). Data analysis was conducted from October 2020 to April 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Factors assessed included meteorological information, such as drought index (Standardized Precipitation-Evapotranspiration Index [SPEI]), Aridity Index, rainfall, temperature, and vegetation indices; demographic and economic development factors (nighttime light emissions, driving time to the nearest city); and land topography (slope angle, elevation above sea level).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The main outcomes were height-for-age z score (HAZ), weight-for-age z score (WAZ), and weight-for-height z score (WHZ). Spatial resolution estimates, at 1 km × 1 km of childhood growth faltering indicators, were created.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 5219 individuals aged 0 to 59 months included in the analysis, 2633 (50%) were female; mean (SD) age was 29 (17) months. Of these individuals, 30.22% (95% CI, 29.36%-30.98%) had stunting, 12.23% (95% CI, 11.55%-12.91%) had underweight, and 3.63% (95% CI, 3.46%-3.80%) had wasting. Large disparities in the burden of childhood growth faltering existed within Uganda at smaller and larger spatial scales; villages in the northeastern and southwestern areas of the country had the highest prevalence of all forms of growth faltering (stunting, &gt;40%; underweight, &gt;16%; and wasting, &gt;6%). Higher SPEI at 3 months before birth was positively associated with all childhood growth outcomes: HAZ (β, 0.06; 95% CI, 0.02-0.10), WAZ (β, 0.04; 95% CI, 0.01-0.07), and WHZ (β, 0.03; 95% CI, 0.001-0.06). Higher location mean rainfall 11 months before birth was also positively associated with HAZ (β, 0.06; 95% CI, 0.01-0.10). Aridity Index associations with WAZ (β, 0.09; 95% CI, 0.04-0.13) and WHZ (β, 0.09; 95% CI, 0.02-0.16) were consistent with findings for SPEI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study of 5219 individuals 0 to 59 months of age in Uganda, rainfall and long-term availability of water at preconception and during gestation were positively associated with nutritional child growth outcomes. Understanding the relative contributions of meteorological environment factors on the spatial distribution of undernutrition at various spatial scales within Uganda (from the village to the district level) may hel","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251122"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657384","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":"Generalizability of Treatment Outcome Prediction Across Antidepressant Treatment Trials in Depression.","authors":"Peter Zhukovsky, Madhukar H Trivedi, Myrna Weissman, Ramin Parsey, Sidney Kennedy, Diego A Pizzagalli","doi":"10.1001/jamanetworkopen.2025.1310","DOIUrl":"10.1001/jamanetworkopen.2025.1310","url":null,"abstract":"<p><strong>Importance: </strong>Although several predictive models for response to antidepressant treatment have emerged on the basis of individual clinical trials, it is unclear whether such models generalize to different clinical and geographical contexts.</p><p><strong>Objective: </strong>To assess whether neuroimaging and clinical features predict response to sertraline and escitalopram in patients with major depressive disorder (MDD) across 2 multisite studies using machine learning and to predict change in depression severity in 2 independent studies.</p><p><strong>Design, setting, and participants: </strong>This prognostic study included structural and functional resting-state magnetic resonance imaging and clinical and demographic data from the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) randomized clinical trial (RCT), which administered sertraline (in stage 1 and stage 2) and placebo, and the Canadian Biomarker Integration Network in Depression (CANBIND-1) RCT, which administered escitalopram. EMBARC recruited participants with MDD (aged 18-65 years) at 4 academic sites across the US between August 2011 and December 2015. CANBIND-1 recruited participants with MDD from 6 outpatient centers across Canada between August 2013 and December 2016. Data were analyzed from October 2023 to May 2024.</p><p><strong>Main outcomes and measures: </strong>Prediction performance for treatment response was assessed using balanced classification accuracy and area under the curve (AUC). In secondary analyses, prediction performance was assessed using observed vs predicted correlations between change in depression severity.</p><p><strong>Results: </strong>In 363 adult patients (225 from EMBARC and 138 from CANBIND-1; mean [SD] age, 36.6 [13.1] years; 235 women [64.7%]), the best-performing models using pretreatment clinical features and functional connectivity of the dorsal anterior cingulate had moderate cross-trial generalizability for antidepressant treatment (trained on CANBIND-1 and tested on EMBARC, AUC = 0.62 for stage 1 and AUC = 0.67 for stage 2; trained on EMBARC stage 1 and tested on CANBIND-1, AUC = 0.66). The addition of neuroimaging features improved the prediction performance of antidepressant response compared with clinical features only. The use of early-treatment (week 2) instead of pretreatment depression severity scores resulted in the best generalization performance, comparable to within-trial performance. Multivariate regressions showed substantial cross-trial generalizability in change in depression severity (predicted vs observed r ranging from 0.31 to 0.39).</p><p><strong>Conclusions and relevance: </strong>In this prognostic study of depression outcomes, models predicting response to antidepressants show substantial generalizability across different RCTs of adult MDD.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251310"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663514","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":"Notice of Retraction. Xu LL, et al. Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(4):e239321.","authors":"Xin-Zhong Chen, Dong-Xin Wang","doi":"10.1001/jamanetworkopen.2025.6386","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.6386","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e256386"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718938","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":"Older Adults' Views on Insurance Coverage for Weight Management Medications.","authors":"Lauren Oshman, Matthias Kirch, Erica Solway, Dianne C Singer, Preeti N Malani, J Scott Roberts, Jeffrey T Kullgren, Dina Hafez Griauzde","doi":"10.1001/jamanetworkopen.2025.2008","DOIUrl":"10.1001/jamanetworkopen.2025.2008","url":null,"abstract":"<p><strong>Importance: </strong>Medicare and many commercial insurers do not cover US Food and Drug Administration-approved weight management medications, such as incretin mimetics (semaglutide, tirzepatide, and liraglutide), bupropion-naltrexone, and phentermine-topiramate).</p><p><strong>Objectives: </strong>To assess older adults' interest in weight management medications and associated characteristics and to understand their perceptions about insurance coverage of weight management medications.</p><p><strong>Design, setting, and participants: </strong>This survey study used cross-sectional data from a nationally representative sample of US adults ages 50 to 80 years from the July 2023 National Poll on Healthy Aging. Data were analyzed from August to November 2023.</p><p><strong>Main outcomes and measures: </strong>Outcomes of interest were estimates of interest in taking weight management medication and perceptions about coverage for US Food and Drug Administration-approved weight management medications by insurers, including Medicare.</p><p><strong>Results: </strong>Among 2657 respondents, 60.3% (95% CI, 56.7%-63.8%) were ages 50 to 64 years, 52.2% (95% CI, 49.8%-54.5%) were female, and 10.6% (95% CI, 9.3%-12.0%) were non-Hispanic Black, 11.4% (95% CI, 10.4%-12.6%) were Hispanic, and 70.3% (95% CI, 68.2%-72.4%) were non-Hispanic White. Overall, 35.1% (95% CI, 31.9%-38.4%) of participants were interested in using weight management medications, including 59.1% (95% CI, 53.4%-64.5%) of individuals with body mass index (BMI) of 30 or greater. Interest was most robustly associated with having used these medications in the past (adjusted odds ratio, 7.57 [95% CI, 4.41-13.02]) and BMI of 30 or greater (adjusted odds ratio, 5.04 [95% CI, 3.48-7.30]). Most participants (of any BMI) agreed that health insurance should cover weight management medications (2176 of 2625 respondents [83.2%]). When asked whether Medicare should cover such medications, most still favored coverage (2097 of 2616 respondents [75.7%]), but fewer approved of paying more for a Medicare premium to ensure coverage (829 of 2604 respondents [30.2%]).</p><p><strong>Conclusions and relevance: </strong>In this survey study of older US adults, most participants agreed that Medicare should cover weight management medications and more than half of those with BMI of 30 or greater were interested in using them. These results should inform decisions to include weight management medications in the Medicare and commercial insurance programs, as well as utilization policies to control health care costs.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e252008"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709732","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}