JAMA Health Forum最新文献

{"title":"US State Statutes Addressing Unilateral Clinician Decisions About Life-Sustaining Treatment.","authors":"Gina M Piscitello, Michael T Huber, Leigh Meyer, Patrick G Lyons, William F Parker, Erin S DeMartino","doi":"10.1001/jamahealthforum.2025.3508","DOIUrl":"10.1001/jamahealthforum.2025.3508","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253508"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Author Initials.","authors":"","doi":"10.1001/jamahealthforum.2025.3831","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3831","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253831"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Health Consequences of Nonhealth Policies in a Time of Policy Disruption.","authors":"Sandro Galea","doi":"10.1001/jamahealthforum.2025.2101","DOIUrl":"10.1001/jamahealthforum.2025.2101","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252101"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prices and Affordability of Essential Medicines in 72 Low-, Middle-, and High-Income Markets.","authors":"Olivier J Wouters, Cyprien Denolle, Jinru Wei, Irene Papanicolas","doi":"10.1001/jamahealthforum.2025.2043","DOIUrl":"10.1001/jamahealthforum.2025.2043","url":null,"abstract":"<p><strong>Importance: </strong>Little is known about how the prices and affordability of medicines included on the World Health Organization's Model List of Essential Medicines vary across the globe.</p><p><strong>Objective: </strong>To compare the list prices and affordability of essential medicines across high-, middle-, and low-income markets.</p><p><strong>Design and setting: </strong>This cross-sectional study examined data from 2022 on list prices and volumes of 549 essential medicines in 72 high-, middle-, and low-income markets (covering 87 countries). These data were obtained from IQVIA. The statistical analyses were performed between August 2024 and March 2025.</p><p><strong>Main outcomes and measures: </strong>Laspeyres price indices were used to compare average drug prices across countries, both in nominal and purchasing power parity-adjusted terms. The affordability of 8 essential medicines, used to treat major causes of death and disability globally, was assessed by calculating how many days of minimum wage would be required to pay for 1 month of treatment.</p><p><strong>Results: </strong>The availability of essential medicines ranged from 225 (41%) in Kuwait to 438 (80%) in Germany (base country). After accounting for purchasing power parities, prices of essential medicines in Lebanon were, on average, 18.1% of those in Germany (Lebanon price index, 18.1 vs Germany price index, 100), while average prices in the US were 3.0 times higher than in Germany (US price index, 298.2). A positive association was observed between countries' gross domestic product per capita (expressed in logarithmic terms) and nominal drug prices (R = 0.30; P = .01), indicating that richer countries generally had higher drug prices. However, when adjusting for the purchasing power of different currencies, an inverse association was observed (R = -0.35; P = .003), suggesting that richer countries had lower real prices. Drug affordability, as measured by the number of days' minimum wage needed to purchase a month's treatment, varied widely, with median affordability highest in Europe and the Western Pacific, and lowest in Africa and Southeast Asia.</p><p><strong>Conclusions and relevance: </strong>The results of this cross-sectional analysis showed significant variation in the prices and affordability of 549 essential medicines across 72 markets in 2022. Strategies to promote equitable drug prices and improve drug affordability are urgently needed.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252043"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Innovations to Improve Black Maternal Health.","authors":"Kaytura Felix, Ruth S Shim","doi":"10.1001/jamahealthforum.2025.4411","DOIUrl":"10.1001/jamahealthforum.2025.4411","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e254411"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating 8 Area-Based Measures of Social Risk for Predicting Health and Mortality.","authors":"Aubrey Limburg, David H Rehkopf, Nicole Gladish, Robert L Phillips, Victoria Udalova","doi":"10.1001/jamahealthforum.2025.2669","DOIUrl":"10.1001/jamahealthforum.2025.2669","url":null,"abstract":"<p><strong>Importance: </strong>Area-based measures of social risk are increasingly being used in policy applications in the US. While several have been demonstrated to be predictive of health and mortality in the general population, there is a need to identify area-based measures that are most reliable for policy applications, including measures that are associated with health and mortality consistently across subpopulations.</p><p><strong>Objective: </strong>To compare the relative strength with which area and individual social risk measures are correlated with health outcomes and mortality, and the extent to which these associations are consistent across race, ethnicity, rurality, age, and gender.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included a sample of patients from primary care clinics across all 50 states that are part of the PRIME registry using electronic health records (2019-2021) linked to US Census Bureau restricted-use data at the individual level from 947 US primary care practices.</p><p><strong>Exposures: </strong>Eight commonly used area based measures of social risk were examined: (1) Social Deprivation Index, (2) Social Vulnerability Index, (3) Area Deprivation Index (from University of Wisconsin), (4) Area Deprivation Index (constructed using Gophal Singh's original design), (5) Neighborhood Stress Score, (6) Index of Concentration at the Extremes for race and income, (7) French Index of Social Deprivation, and (8) the Community Resilience Estimates. Individual socioeconomic measures of education, poverty, and occupation were also examined.</p><p><strong>Main outcomes and measures: </strong>Hypertension, diabetes, and chronic kidney disease derived from electronic health records, and mortality from the Census Numident.</p><p><strong>Results: </strong>Data from 2 801 000 patients were analyzed. Among these, 44% were male individuals and 56% were female individuals; 20% were younger than 25 years, 23% were aged 25 to 44 years, 30% were aged 45 to 64 years, and 27% were aged 65 years and older; 0.5% were American Indian or Alaskan Native, 2.1% Asian, 7.6% Black, 0.2% Native Hawaiian and Pacific Islander, 0.03% were 2 or more races, and 70% were White. Area-based measures of social risk were generally better predictors of hypertension, diabetes, and chronic kidney disease, whereas individual socioeconomic measures were generally better predictors of mortality. The strongest predictor across health outcomes was the Area Deprivation Index, and that Gopal Singh's version was the most equitably predictive across rural areas and across all racial and ethnic subgroups.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, area-based measures predicted health outcomes better than individual socioeconomic measures, and generally predicted health equitably across subpopulations; thus, their use should be considered in conjunction or instead of using individual-level ","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252669"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Statewide Fentanyl Possession Law and Opioid-Related Overdose Deaths.","authors":"Cole Jurecka, Joella Adams, Pranav Padmanabhan, Jason Glanz, Paul Christine, Xiaoyu Guan, Danielle Kline, Ingrid Binswanger, Joshua Barocas","doi":"10.1001/jamahealthforum.2025.2654","DOIUrl":"10.1001/jamahealthforum.2025.2654","url":null,"abstract":"<p><strong>Importance: </strong>In 2022, Colorado passed legislation making possession of small amounts of fentanyl, a high-potency synthetic opioid, a felony. Whether the Colorado law affected opioid overdose fatalities and whether those effects differed by racial and ethnic subgroups is unknown.</p><p><strong>Objective: </strong>To estimate the association between the change in criminal penalties for fentanyl possession with opioid-related overdose deaths (OODs) in Colorado.</p><p><strong>Design, setting, and population: </strong>Serial cross-sectional study comparing OODs among adults (≥18 years) who died of an overdose and population estimates before and after Colorado House Bill (HB) 22-1326 was enacted in July 2022 (January 2018-November 2023) using autoregressive integrated moving averages (ARIMA) model time series forecasting. Monthly OOD rates per 100 000 residents were calculated using state population estimates from the American Community Survey 5-Year Data and the Colorado Department of Local Affairs State Demography Office. Overdose death rates were calculated separately by racial and ethnic group (Hispanic, non-Hispanic Black, and non-Hispanic White). Data were analyzed from January 2018 to 2023.</p><p><strong>Exposure: </strong>Enactment of HB 22-1326 changed the legal penalty for possession of any drug weighing 1 g to 4 g that contained any amount of fentanyl from a misdemeanor to a level-4 drug felony punishable by up to 180 days in jail and up to 2 years of probation.</p><p><strong>Main outcome: </strong>The difference between expected and observed OOD rates following the enactment of increased criminal penalties.</p><p><strong>Results: </strong>A total of 7099 OODs were analyzed (1798 Hispanic [25.3%], 451 Non-Hispanic Black [6.4%], and 4170 Non-Hispanic White [58.7%], 680 other [9.5%] and not included in the race and ethnicity categories). OODs increased across the study period in Colorado from 20.46 per 100 000 adults in January 2018 to 37.78 per 100 000 adults in November 2023. Among different racial and ethnic groups, the non-Hispanic Black population had the highest increase in OODs (9.3 per 100 000 in 2018 to 56.9 per 100 000 in 2023) followed by the Hispanic population. There was no difference between the observed and expect overdose deaths for the overall population following the enactment of HB 22-1326. However, there were significant increases in 4 of 13 months after policy implementation among the non-Hispanic Black population.</p><p><strong>Conclusions and relevance: </strong>The results of this serial cross-sectional study suggest that increased criminal penalties for fentanyl possession did not change preexisting trends of OODs in Colorado and may have been associated with an increase in opioid overdoses in the Black population. These results should be interpreted in light of increasing opioid overdose rates in Black populations nationally during the study period.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252654"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Policy in Advancing Innovative Trial Designs.","authors":"Alayna Carrandi, Derek C Angus, Alisa M Higgins","doi":"10.1001/jamahealthforum.2025.3028","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3028","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253028"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Costs of Elective Surgical Procedures in Medicare Advantage Compared With Traditional Medicare.","authors":"Eran Politzer, Timothy S Anderson, John Z Ayanian, Vilsa E Curto, Jeffrey Souza, Thomas C Tsai, Bruce E Landon","doi":"10.1001/jamahealthforum.2025.2258","DOIUrl":"10.1001/jamahealthforum.2025.2258","url":null,"abstract":"<p><strong>Importance: </strong>The utilization of elective surgical procedures is lower for patients enrolled in Medicare Advantage (MA) than in traditional Medicare (TM), but it remains unclear whether surgical episode costs differ between MA and TM for comparable patients.</p><p><strong>Objective: </strong>To compare the estimated costs, markers of resource use (eg, length of stay and location of surgery), and outcomes of surgical episodes for similar patients enrolled in MA and TM.</p><p><strong>Design, setting, and participants: </strong>In this retrospective cohort study, 2019 Medicare claims and encounters data were analyzed to compare differences in surgical episode costs for beneficiaries with MA vs TM who underwent common elective surgical procedures across 11 categories. Procedures performed in either inpatient or outpatient settings were included in the analysis. Data were analyzed from January 2023 to March 2025.</p><p><strong>Exposures: </strong>Enrollment in MA or TM.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were estimated 30-day costs of surgical episodes and factors affecting costs and/or outcomes, including share of inpatient procedures, length of stay, share of patients discharged home, and 30-day readmission rates. A secondary outcome explored potential facility selection and patient steering by estimating the distance traveled to surgery. Multivariable linear regression models adjusted for the type of surgical procedure, patient characteristics, and their Elixhauser Comorbidity Index were used to compare outcomes of surgical episodes in patients with MA vs TM within hospital referral regions.</p><p><strong>Results: </strong>The analysis included 1 177 700 surgical procedures among 1 110 263 Medicare beneficiaries (mean [SD] age, 73.42 [5.8] years; 686 708 females [58.3%]). The overall rate of surgery utilization was lower among MA patients vs TM patients (difference in rate, -4.4%; 95% CI, -4.8% to -4.1%), with variation found across surgical categories. Across procedures, 30-day surgical episode costs for MA patients vs TM patients were, on average, $671 (95% CI, $639-$702) lower. The share of procedures billed at the higher inpatient rate was 5.41 (95% CI, 5.23-5.58) percentage points (pp) lower for MA patients than for TM patients, and the mean length of inpatient stay was 0.27 (95% CI, 0.26-0.29) days shorter. The share of patients discharged home was higher for those with MA vs TM (3.82 [95% CI, 3.65-3.99] pp). MA patients traveled a mean of 2.32 (95% CI, 1.62-3.01) miles farther for surgery. Readmission rates were lower for patients with MA (-0.70 [95% CI, -0.83 to -0.58] pp).</p><p><strong>Conclusions and relevance: </strong>This study found that in addition to lower utilization of common elective surgical procedures, the costs of surgical episodes were lower for patients enrolled in MA than those enrolled in TM. MA plans had lower costs because more procedures were performed in outpatien","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252258"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to Essential Medicines-High-Level Insights and Unanswered Questions.","authors":"Andrew L Gray","doi":"10.1001/jamahealthforum.2025.2048","DOIUrl":"10.1001/jamahealthforum.2025.2048","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252048"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}