Annals of Internal Medicine

BackgroundLong COVID affects millions worldwide, yet the long-term trajectory of healthcare costs remains poorly characterized. Prior studies with limited follow-up have documented elevated but stable excess costs, leaving uncertainty about whether the economic burden attenuates or persists over time. MethodsWe conducted a retrospective cohort study using electronic health record data from 12 hospitals and 20 community health centers (January 2018 through December 2024). Adults with documented ...

The long-term impact of SARS-CoV-2 infection on kidney allograft survival remains incompletely understood, particularly regarding the influence of vaccination, acute kidney injury (AKI), and post-infection immunosuppression. We conducted a retrospective analysis of 129 kidney transplant recipients with confirmed SARS-CoV-2 infection between March 2020 and March 2022 with a median follow-up of 50 months. Among 129 recipients, 106 (82%) received vaccination at any time before or after SARS-CoV-2 i...

COVID-19 has been shown to cause a range of harmful long-term effects on nearly every organ system1-3. These findings are based on retrospective studies comparing COVID-19 patients to patients with similar medical histories and demographics but no COVID-19 diagnosis4-16. However, concerns have emerged that these comparisons may be biased if COVID-19 patients had unrelated health conditions or other factors not recorded in their medical records17-21. Here, using a massive dataset of 14.4 billion ...

La Crosse virus (LACV) causes the majority of pediatric arboviral encephalitis cases in the United States, with Ohio historically reporting the highest incidence of LACV neuroinvasive disease (LACV-ND). To identify county-level risk factors, we analyzed two decades (2003-2023) of Ohio surveillance data across all 88 counties using spatial statistical methods. Land-use correlation screening identified deciduous forest cover ({rho} = 0.36, adjusted p = 0.006) and pasture/hay cover ({rho} = 0.37, a...

BackgroundRespiratory viruses are major contributors to population mortality, but cause-of-death coding undercounts their impact. Ecological regression models linking viral circulation to mortality fluctuations can address this limitation. AimTo estimate the population attributable fraction (PAF) of mortality associated with influenza A and B, respiratory syncytial virus (RSV), and SARS-CoV-2 in Ontario, Canada (1993-2024). MethodsWe analysed monthly all-cause mortality data with laboratory su...

BackgroundSocioeconomic disparities in COVID-19 outcomes have been widely documented, but evidence regarding inequities in SARS-CoV-2 transmission remains mixed. In Canada, infection-induced seroprevalence appeared to converge across socioeconomic strata by late 2022, raising questions about whether transmission inequities diminished during the Omicron period. AimTo assess whether apparent convergence in SARS-CoV-2 seroprevalence reflects true equity in transmission or masks persistent socioeco...

SARS-CoV-2 strained Ontarios health system, with social determinants of health (SDH) underexplored in cost analyses. We examined COVID-19 attributable healthcare resource use and costs from the Ontario health system perspective using health administrative data. We conducted a cohort study, matching 162,633 SARS-CoV-2-exposed individuals 1:1 to unexposed individuals. We calculated 10-day per-person mean attributable costs (2023 CAD) across care phases (pre-diagnosis, acute, post-acute, terminal),...

Annual immunisation against both COVID-19 and seasonal influenza is now becoming standard of care, particularly ahead of anticipated winter waves. These vaccines may be co-administered on the same day or sequentially on separate days. Data on immunogenicity and the impact of consecutive vaccinations on spike-specific humoral and cellular immunity in dialysis patients remain limited. In this real-world observational study, SARS-CoV-2-specific immune responses were evaluated in dialysis patients ...

BackgroundAutomated systems, including large language models, are increasingly used to support data extraction in diagnostic systematic reviews. However, their reliability, safety, and repeatability under realistic extraction conditions remain insufficiently characterized. ObjectiveTo benchmark the end-to-end reliability of automated systems for extracting diagnostic accuracy data from published uro-oncologic studies, with a focus on correctness, abstention behavior in non-derivable scenarios, ...

BackgroundA substantial proportion of patients with acute COVID-19 develop post-acute sequelae of SARS-CoV-2 infection (Long COVID). The risk of adverse cardiovascular and related outcomes in Long COVID remain elusive. We hypothesized that individuals with Long COVID are at elevated risk for adverse cardiovascular, renal and pulmonary (CRP) outcomes compared to those who recovered from COVID-19 without developing Long COVID. MethodsWe performed a retrospective cohort study using the global TriN...

BackgroundDelivering timely, high-quality feedback on resident scholarly projects is labour-intensive, especially in large programmes. We developed an AI-assisted evaluation system, powered by the open-weight LLaMA-3.1 large-language model (LLM), to generate formative feedback on Family Medicine residents scholarly projects and compared its performance with expert human evaluators. MethodsWe evaluated whether the AI-generated feedback achieves comparable quality to expert feedback. The tool ing...

AbstractAccurate health information is ineffective if patients cannot understand it. Large Language Model (LLM) health research values veridical precision; however, linguistic accessibility remains an under-examined component of output quality and usability. This study investigated two sources of variability in readability classification: differences across LLM systems and across readability metrics. The analysis tested 1,120 data points from seven systems in English and Portuguese, comparing ba...

This study estimated early vaccine effectiveness (VE) of the BNT162b2 LP.8.1-adapted vaccine against emergency department/urgent care (ED/UC) and outpatient visits using a test-negative case-control design. Patients from the US Veterans Affairs Healthcare System with an acute respiratory infection (ARI) who underwent SARS-CoV-2 testing from September 10 - November 30, 2025 were included. VE was estimated using multivariable logistic regression adjusted for patient demographics and clinical chara...

This exploratory analysis of PAX LC, a Phase 2, 1:1 randomized, double-blind, superiority, placebo-controlled trial examined whether treatment with nirmatrelvir/ritonavir (NMV/r) versus placebo/ritonavir (PBO/r) in individuals with Long COVID could reveal immune features associated with symptom improvement. Eighty-two participants (n=45 PBO/r; n=37 NMV/r) provided blood samples at baseline (Day 0) and post-treatment (Day 28). Baseline demographic and immunological phenotypes were similar in the ...

Large language models (LLMs) offer new opportunities to synthesize the vast and heterogeneous biomedical literature, yet their potential to support drug target prioritization in complex diseases such as Alzheimers disease (AD) remains largely unexplored. Here, we introduce an LLM-driven framework that evaluates and ranks AD therapeutic targets across six criteria central to pharmaceutical decision-making: biological confidence, technical feasibility, clinical developability, patient impact, comp...

BackgroundRetrieval-augmented generation (RAG) frameworks such as RAPID [1] have demonstrated that staged planning and retrieval grounding improve long-form text generation. However, most implementations remain similarity-driven and open-domain, lacking the epistemic safeguards required for biomedical synthesis, where mechanistic completeness, temporal governance, traceability, and explicit gap classification are essential. ObjectiveTo develop and evaluate a topology-aware, graph-augmented retr...

RationaleObstructive sleep apnea (OSA) is linked to cardiovascular, metabolic, and cognitive morbidity. Although COVID-19 has been associated with long-term respiratory and neurological sequelae, its role in precipitating new-onset OSA remains unclear. ObjectivesTo evaluate whether SARS-CoV-2 infection increases risk of developing OSA up to 4.5 years post-infection and how risk varies by hospitalization status, demographics, comorbidities, and vaccination status. MethodsThis retrospective coho...

Background: Population cancer screening detects the presence of early-stage disease rather than assessing future disease risk. We evaluated whether widely implemented cardiovascular disease (CVD) risk models can predict 10-year cancer risk, comparing them with the QCancer risk model. Methods: We evaluated four CVD prediction models: QRISK3, PCE, and SCORE2/SCORE2-OP. Models were recalibrated using 20% of the UK Biobank (UKB) cohort and tested in the remainder and in the Clinical Practice Researc...

PuhrposeTo evaluate the short- and long-term cross-sectional associations between COVID-19 infection and multidimensional sleep health. MethodsData from the COVID-19 Outbreak Public Evaluation (COPE) initiative were used to examine the association between a novel multidimensional sleep health measure (COPE Multidimensional Sleep Health Scale, CMSHS) modeled from the RuSATED instrument and (1) COVID-19 infection and (2) post-acute sequelae of SARS-CoV-2 infection (PASC). ResultsData from 11,326...

In death certificates Entity Axis reflects reported death causes in their original order, and Record Axis reflects standardized re-classifications processed with expert rules. Additionally, while conventional mortality statistics consider a single underlying cause ignoring multiple contributing conditions, weighting schemes may consider all listed causes. We evaluated the impact of re-classification and weighting schemes across all 56,986,831 US death certificates from 2003-2023. ICD-10 codes we...