Tag: JAMA

Causal Inference About the Effects of Interventions From Observational Studies in Medical Journals

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama/fullarticle/2818746?guestAccessKey=66ec96e3-d156-46cf-928b-ff8b2a8fc35e&utm_source=silverchair&utm_medium=email&utm_campaign=content_max-jamainternalmedicine&utm_content=olf&utm_term=051324&utm_adv=000004014036

Additional editors’ note: https://jamanetwork.com/journals/jama/fullarticle/2818747?guestAccessKey=8b28cc16-c1e5-4a09-bec6-1f77abfe98db&utm_source=silverchair&utm_medium=email&utm_campaign=content_max-jamainternalmedicine&utm_content=olf&utm_term=051324&utm_adv=000004014036

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Abstract:

Importance  Many medical journals, including JAMA, restrict the use of causal language to the reporting of randomized clinical trials. Although well-conducted randomized clinical trials remain the preferred approach for answering causal questions, methods for observational studies have advanced such that causal interpretations of the results of well-conducted observational studies may be possible when strong assumptions hold. Furthermore, observational studies may be the only practical source of information for answering some questions about the causal effects of medical or policy interventions, can support the study of interventions in populations and settings that reflect practice, and can help identify interventions for further experimental investigation. Identifying opportunities for the appropriate use of causal language when describing observational studies is important for communication in medical journals.

Observations  A structured approach to whether and how causal language may be used when describing observational studies would enhance the communication of research goals, support the assessment of assumptions and design and analytic choices, and allow for more clear and accurate interpretation of results. Building on the extensive literature on causal inference across diverse disciplines, we suggest a framework for observational studies that aim to provide evidence about the causal effects of interventions based on 6 core questions: what is the causal question; what quantity would, if known, answer the causal question; what is the study design; what causal assumptions are being made; how can the observed data be used to answer the causal question in principle and in practice; and is a causal interpretation of the analyses tenable?

Conclusions and Relevance  Adoption of the proposed framework to identify when causal interpretation is appropriate in observational studies promises to facilitate better communication between authors, reviewers, editors, and readers. Practical implementation will require cooperation between editors, authors, and reviewers to operationalize the framework and evaluate its effect on the reporting of empirical research.

Author(s): Issa J. Dahabreh, MD, ScD1,2,3,4,5; Kirsten Bibbins-Domingo, PhD, MD, MAS6,7,8

Publication Date: 9 May 2024

Publication Site: JAMA

doi:10.1001/jama.2024.7741

The Paradoxical Decline of Geriatric Medicine as a Profession

Mary Pat Campbell

Link:https://jamanetwork.com/journals/jama/article-abstract/2808221

DOI: JAMA. 2023;330(8):693-694. doi:10.1001/jama.2023.11110

Excerpt:

Thirty-five years ago, geriatrics officially became a specialty of medicine. At that time, there were 76 million baby boomers who would begin turning 65 in 2011, a compelling demographic imperative for this new specialty that specifically focused on older adults.

Geriatrics is a field especially attractive to some physicians because of its differences from other specialties, including elements beyond single medical conditions such as multimorbidity, polypharmacy, function, and cognition. Geriatrics also places a special emphasis on interdisciplinary team care for complex older patients, and the needs of family caregivers.

Author(s):Jerry H. Gurwitz, MD1

Publication Date: 4 Aug 2023

Publication Site: JAMA

Who Will Care for Older Adults? We’ve Plenty of Know-How but Too Few Specialists

Mary Pat Campbell

Link: https://kffhealthnews.org/news/article/who-will-care-for-older-adults-weve-plenty-of-know-how-but-too-few-specialists/

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Excerpt:

Despite the surging older population, there are fewer geriatricians now (just over 7,400) than in 2000 (10,270), he noted in a recent piece in JAMA. (In those two decades, the population 65 and older expanded by more than 60%.) Research suggests each geriatrician should care for no more than 700 patients; the current ratio of providers to older patients is 1 to 10,000.

What’s more, medical schools aren’t required to teach students about geriatrics, and fewer than half mandate any geriatrics-specific skills training or clinical experience. And the pipeline of doctors who complete a one-year fellowship required for specialization in geriatrics is narrow. Of 411 geriatric fellowship positions available in 2022-23, 30% went unfilled.

The implications are stark: Geriatricians will be unable to meet soaring demand for their services as the aged U.S. population swells for decades to come. There are just too few of them. “Sadly, our health system and its workforce are wholly unprepared to deal with an imminent surge of multimorbidity, functional impairment, dementia and frailty,” Gurwitz warned in his JAMA piece.

This is far from a new concern. Fifteen years ago, a report from the National Academies of Sciences, Engineering, and Medicine concluded: “Unless action is taken immediately, the health care workforce will lack the capacity (in both size and ability) to meet the needs of older patients in the future.” According to the American Geriatrics Society, 30,000 geriatricians will be needed by 2030 to care for frail, medically complex seniors.

Author(s): Judith Graham

Publication Date: 10 Nov 2023

Publication Site: Kaiser Health News

The Shady Statistics Behind the War on Painkillers

Mary Pat Campbell

Link: https://reason.com/video/2023/10/11/the-shady-statistics-behind-the-war-on-painkillers/

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Excerpt:

The attack on opioid prescriptions for non-cancer chronic pain began to advance around 2010, and intensified thereafter. The crackdown coincided with—and perhaps caused—a rapid growth in heroin overdose deaths, and later, an explosion in illegal synthetic opioid deaths, primarily fentanyl, an illicitly manufactured substance added to or substituted for heroin to meet the increasing demand for illegal opiates. This pattern of events is illustrated in a graphic put out by the Centers for Disease Control (CDC).

Indeed, overdose deaths from commonly prescribed opiates increased rapidly from 1999 to 2010, but the chart doesn’t tell us how many of the victims legally obtained the opiates. The chosen scale also omits the fact that drug overdose deaths have been increasing at a fairly steady rate since 1979, with no obvious changes associated with the rise and fall of opioid prescriptions for chronic pain. The chart does show how overdose death rates from commonly prescribed opiates did not decline much after 2010, although legal prescriptions went down dramatically. This suggests that these deaths may have involved individuals who bought illegally manufactured opiates, or that the people who lost pain medication as a result of official actions were not the ones liable to overdose.

The increase in deaths of despair obviously merits some policy attention, but labeling it an “opioid crisis,” as is common nowadays, profoundly misstates its nature, timing, and likely causes and solutions. To justify restricting opioids for non-cancer chronic pain patients requires specific evidence that people prescribed opioids for pain are the ones dying of overdoses. There’s quite a bit of negative evidence on this score, but public health officials have seized on a few positive studies to support their claims.

One influential and heavily cited 2011 study published in the Journal of the American Medical Association, “Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths,” uses a classic prohibitionist tactic. The authors use a sample of 750 Veterans Health Administration (VHA) patients who received opioid prescriptions for pain and later died of opioid overdoses, and compare them to a random sample of 155,000 other VHA patients who received opioid prescriptions and did not die of overdoses.

Author(s): Aaron Brown

Publication Date: 11 Oct 2023

Publication Site: Reason

One-Year Adverse Outcomes Among US Adults With Post–COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802095

JAMA Health Forum. 2023;4(3):e230010. doi:10.1001/jamahealthforum.2023.0010

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Excerpt:

Key Points

Question  Do postacute sequelae of SARS-CoV-2 increase risks of 1-year adverse outcomes?

Findings  In this case-control study of 13 435 US adults with post–COVID-19 condition (PCC) and 26 870 matched adults without COVID-19, the adults with PCC experienced increased risks for a number of cardiovascular outcomes, such as ischemic stroke. During the 12-month follow-up period, 2.8% of the individuals with PCC vs 1.2% of the individuals without COVID-19 died, implying an excess death rate of 16.4 per 1000 individuals.

Meaning  Individuals with PCC may be at increased risk for adverse outcomes in the year following initial infection.

Author(s): Andrea DeVries, PhD1; Sonali Shambhu, BDS, MPH1; Sue Sloop, PhD1; et al

Publication Date:

Publication Site: JAMA Health Forum

Long COVID Correlates With High Mortality: Health Insurer

Mary Pat Campbell

Link: https://www.thinkadvisor.com/2023/03/03/long-covid-correlates-with-high-mortality-health-insurer/

Excerpt:

A giant health insurer says health plan enrollees who suffered from long COVID-19 symptoms were more than twice as likely as other enrollees to die during a 12-month follow-up period.

Andrea DeVries, a researcher at Elevance Health, and three colleagues found that, during the year studied, 2.8% of the 13,435 enrollees classified as having “post-COVID-19 condition” died, according to a study published in the JAMA Health Forum, which is affiliated with the Journal of the American Medical Association.

That compares with a death rate of just 1.2% for similar enrollees without COVID-19 during the same period.

….

Elevance Health is the company formerly known as Anthem. The company provides or administers major medical coverage for about 48 million people.

The DeVries looked at claim records for 249,013 Elevance plan enrollees ages and older who were diagnosed with COVID-19 from April 1, 2020, through July 31, 2020 — before regulators had adopted a long COVID diagnosis code.

The team began by identifying enrollees with COVID-19 who had been enrolled in an Elevance plan for at least five months before being diagnosed with COVID-19 and who had survived for at least two months after the diagnosis date.

Because of the lack of a long COVID-19 diagnosis code, the team used claims for other conditions, such as loss of the sense of smell, brain fog, anxiety and heart rate problems, to come up with a list of enrollees with long COVID.

Author(s): Allison Bell

Publication Date: 3 March 2023

Publication Site: Think Advisor

More Americans 65 and Under Died from Alcohol-Related Causes Than Covid-19 in 2020, Study Finds

Mary Pat Campbell

Link: https://www.nationalreview.com/news/more-americans-65-and-under-died-from-alcohol-related-causes-than-covid-19-in-2020-study-finds/

Excerpt:

Alcohol-related deaths increased 25 percent from 2019 to 2020, with alcohol-related deaths among adults younger than 65 outnumbering deaths from Covid-19 in the same age group in 2020, a new study found.

Alcohol-related deaths, including from liver disease and accidents, increased to 99,017 in 2020, up from 78,927 the year prior, according to the study performed by researchers with the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health.

While 74,408 Americans ages 16 to 64 died of alcohol-related causes, 74,075 individuals under 65 died of Covid-19, the study found. The rate of increase for alcohol-related deaths in 2020 (25 percent) was greater than the rate of increase of deaths from all causes (16.6 percent).

The study shows just another unintended consequence of Covid-19 lockdowns and mitigation measures.

Author(s): Brittany Bernstein

Publication Date: 22 March 2022

Publication Site: National Review

‘We’re losing IQ points’: the lead poisoning crisis unfolding among US children

Mary Pat Campbell

Link:https://www.theguardian.com/us-news/2021/dec/08/lead-poisoning-crisis-us-children

Excerpt:

Turokk Dow is one of about 87,000 young children who are diagnosed with lead poisoning in the US each year, more than three decades after the neurotoxin was banned as an ingredient in paint, gasoline and water pipes. Today, lead lingers in houses and apartments, yards and water lines, and wherever states and communities ramp up testing, it becomes clear that the nation’s lead problem is worse than we realized, experts say.

A study published in JAMA Pediatrics this fall suggested that more than half of all US children have detectable levels of lead in their blood – and that elevated blood lead levels were closely associated with race, poverty and living in older housing. Black children are particularly at risk.

“Most American children are exposed to lead, a substance that is not safe at any level,” said co-author Dr Harvey Kaufman, a senior medical director at Quest Diagnostics, which led the study. According to the CDC, “[e]ven low levels of lead in blood have been shown to negatively affect a child’s intelligence, ability to pay attention, and academic achievement.”

….

In California, for example, a 2020 report found that 1.4 million low-income children who were supposed to receive testing never got checked for blood poisoning. In some states, like New York, testing of all children is required, but there is often insufficient followup. A study by the New York City comptroller found that 9,000 rental buildings where children tested positive for blood poisoning were never inspected for lead, resulting in additional children being poisoned.

Author(s): Erin McCormick in Rhode Island and Eric Lutz

Publication Date: 8 Dec 2021

Publication Site: The Guardian UK

Estimated US Infection- and Vaccine-Induced SARS-CoV-2 Seroprevalence Based on Blood Donations, July 2020-May 2021

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama/fullarticle/2784013

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Excerpt:

Findings  In this repeated cross-sectional study that included 1 443 519 blood donation specimens from a catchment area representing 74% of the US population, estimated SARS-CoV-2 seroprevalence weighted for differences between the study sample and general population increased from 3.5% in July 2020 to 20.2% for infection-induced antibodies and 83.3% for combined infection- and vaccine-induced antibodies in May 2021. Seroprevalence differed by age, race and ethnicity, and geographic region of residence, but these differences changed over the course of the study.

Meaning  Based on a sample of blood donations in the US from July 2020 through May 2021, estimated SARS-CoV-2 seroprevalence increased over time and varied by age, race and ethnicity, and geographic region.

Author(s): Jefferson M. Jones, MD, MPH1; Mars Stone, PhD2; Hasan Sulaeman, MS2; et al

Publication Date: 2 September 2021

Publication Site: JAMA

Mortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama/fullarticle/2735063

Reference: JAMA. 2019;321(21):2131-2133. doi:10.1001/jama.2019.4185

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Excerpt:

In the United States, an estimated 28.7% of adults aged 65 years or older fell in 2014.1 Falls result in increased morbidity, mortality, and health care costs.1,2 Risk factors for falls include age, medication use, poor balance, and chronic conditions (ie, depression, diabetes).1 Fall prevention strategies are typically recommended for adults older than 65 years. In several European countries, an increase in mortality from falls has been observed since 2000, particularly among adults older than 75 years.3,4 This age group has the highest fall risk and potential for cost-effective interventions. We report trends in mortality from falls for the US population aged 75 years or older from 2000 to 2016.

Author(s): Klaas A. Hartholt, MD, PhD1; Robin Lee, PhD, MPH2; Elizabeth R. Burns, MPH2; et al

Publication Date: 4 June 2019

Publication Site: JAMA

Study: U.S. had 23% more deaths than expected in 2020 due to pandemic

Mary Pat Campbell

Link: https://www.upi.com/Health_News/2021/04/02/coronavirus-excess-deaths-study/7781617369688/

Excerpt:

The United States saw 23% more deaths than expected between March 1, 2020, and the start of this year, due primarily to the effects of the COVID-19 pandemic, which suggests the official number of U.S. coronavirus deaths is an undercount, according to an analysis published Friday by JAMA found.

More than 2.8 million people died nationally between when the first confirmed cases of the coronavirus were identified and Jan. 2, the data showed.

That’s roughly 522,000 more than would be expected for the 10-month period, based on figures from 2014 through 2019.

These excess deaths were higher than the number of publicly reported COVID-19 deaths across the country, researchers said.

Author(s): Brian P. Dunleavy

Publication Date: 2 April 2021

Publication Site: UPI

Excess Deaths From COVID-19 and Other Causes in the US, March 1, 2020, to January 2, 2021

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama/fullarticle/2778361

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Excerpt:

Between March 1, 2020, and January 2, 2021, the US experienced 2 801 439 deaths, 22.9% more than expected, representing 522 368 excess deaths (Table). The excess death rate was higher among non-Hispanic Black (208.4 deaths per 100 000) than non-Hispanic White or Hispanic populations (157.0 and 139.8 deaths per 100 000, respectively); these groups accounted for 16.9%, 61.1%, and 16.7% of excess deaths, respectively. The US experienced 4 surge patterns: in New England and the Northeast, excess deaths surged in the spring; in the Southeast and Southwest, in the summer and early winter; in the Plains, Rocky Mountain, and far West, primarily in early winter; and in the Great Lakes, bimodally, in the spring and early winter (Figure). Excess deaths were increasing in all regions at the end of 2020. The 10 states with the highest per capita rate of excess deaths were Mississippi, New Jersey, New York, Arizona, Alabama, Louisiana, South Dakota, New Mexico, North Dakota, and Ohio. New York experienced the largest relative increase in all-cause mortality (38.1%). Deaths attributed to COVID-19 accounted for 72.4% of US excess deaths.

Joinpoint analyses revealed an increase in weekly mortality from non–COVID-19 causes, including heart disease from March 15 to April 11, 2020 (APC, 4.9 [95% CI, 0.7-9.3]), and October 11, 2020, to January 2, 2021 (APC, 1.1 [95% CI, 0.8-1.4]); Alzheimer disease/dementia from March 15 to April 11, 2020 (APC, 7.1 [95% CI, 2.4-12.0]), May 31 to August 15, 2020 (APC, 1.2 [95% CI, 0.7-1.6]), and September 6, 2020, to January 2, 2021 (APC, 1.3 [95% CI, 1.1-1.5]); and diabetes from March 8 to April 11, 2020 (APC, 6.5 [95% CI, 2.8-10.3]), May 31 to July 11, 2020 (APC, 2.6 [95% CI, 0.2-5.0]), and October 18, 2020, to January 2, 2021 (APC, 2.2 [95% CI, 1.6-2.8]).

Author(s): Steven H. Woolf, MD, MPH1; Derek A. Chapman, PhD1; Roy T. Sabo, PhD2; et al

Publication Date: 2 April 2021

Publication Site: JAMA