Yusuke Tsugawa

Authors investigate whether the association between diabetes and suicide risk varies by area-level deprivation. They conducted a matched-pair cohort study using a nationwide health insurance database in Japan. Individuals with diabetes were matched 1:1 with those without diabetes by age, sex, and insurance status (i.e., insured person or their dependents). Area-level deprivation was assessed with a census-based Areal Deprivation Index (ADI). A Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of suicide for individuals with diabetes by area-level deprivation level.

Findings: Among 5,31 million individuals (54.8% men, mean age 52.9 years), we observed 760 suicides. Individuals with diabetes experienced a higher risk of suicide than those without diabetes. The association between diabetes and suicide was stronger in less deprived areas than more deprived areas. Findings suggest greater psychosocial challenges of diabetes diagnosis and management faced by individuals living in less deprived areas, or a possibility that diabetes diagnosis may reduce disparities by improving healthcare access in more deprived areas.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to decrease blood glucose levels, promote weight loss, and prevent cardiovascular events. However, evidence is limited regarding their effect on dementia, although emerging observational studies, some with serious methodological limitations, have suggested large reductions in dementia associated with GLP-1RAs that may not be entirely causally related.

From 2016 to December 2020, authors conducted a trial emulation to compare the effect of GLP-1RAs versus dipeptidyl peptidase-4 inhibitors (DPP4is) as second-line therapy for type 2 diabetes on risk for dementia among older adults. Participants were Medicare fee-for-service beneficiaries aged 66 years or older with diabetes who used metformin and did not have dementia at baseline and initiated GLP-1RAs or DPP4is between January 2017 and December 2018.

Findings: Among older adults with diabetes, no clear evidence was found that the incidence of dementia differed overall between patients using GLP-1RAs versus DPP4is. Under conventional statistical criteria, an effect of GLP-1RAs between a 39% decrease and a 5% increase in risk for dementia was highly compatible with the data, although estimates differed by age. Randomized trials are needed to quantify the effect of GLP-1RAs on dementia. 

To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan. This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Authors analyzed the rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics.

Findings: Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients more than those in Eastern Japan.

Between August 2020 and April 2024, U.S. hospitals were mandated to report weekly occupancy to the Department of Health and Human Services as part of COVID-19 data tracking efforts. Authors repurposed this COVID-19 dashboard to describe several possible U.S. hospital bed occupancy scenarios arising from an aging U.S. population over the next decade, while varying hospitalization rates and staffed hospital bed supply.

Findings: The mean U.S. hospital occupancy was 63.9% from 2009 to 2019 compared with 75.3% in the year following the end of the COVID-19 public health emergency (PHE). The number of staffed hospital beds declined from a prepandemic steady state of 802,000 (2009–2019 mean) to a post-PHE steady state of 674,000, whereas the mean daily census steady state remained at approximately 510,000. There was substantial state-to-state variation in the post-PHE hospital occupancy steady state.

Without changes in the hospitalization rate or staffed hospital bed supply, total annual hospitalizations were projected to increase from 36,174,000 in 2025 to 40,177,000 in 2035 with the aging population. This would correspond to a national hospital occupancy of approximately 85% by 2032 for adult beds and by 2035 for adult and pediatric beds combined.

Experts in developed countries have posited that a national hospital occupancy of 85% constitutes a hospital bed shortage (a conservative estimate). The findings show that the U.S. could reach this dangerous threshold as soon as 2032, with some states at much higher risk than others. These scenarios suggest that an increase in the staffed hospital bed supply by 10%, reduction in the hospitalization rate by 10%, or some combination of the two would offset the aging-associated increase in hospitalizations over the next decade.