Epic Research

Low-Dose Aspirin Usage for Primary Prevention of Cardiovascular Disease Has Fallen by More Than Half Since 2018

Thu, 16 Apr 2026 11:00:00 +0000

Low-dose aspirin (typically 81 mg taken daily) was long recommended to help prevent a first heart attack or stroke in adults at elevated cardiovascular risk. Based on earlier trial evidence, the 2016 U.S. Preventive Services Task Force (USPSTF) endorsed daily aspirin for adults aged 50–69 with at least a 10% ten-year risk of cardiovascular disease (CVD) who were not at increased risk for bleeding.¹ However, three large trials published in 2018 (ARRIVE², ASCEND³, and ASPREE⁴) found that the cardiovascular benefits of aspirin for primary prevention were smaller than previously observed and were largely offset by an increased risk of serious bleeding. These findings prompted major guideline revisions: the 2019 ACC/AHA guideline recommended against routine primary-prevention aspirin and limited consideration to select adults aged 40–70 at higher CVD risk,⁵ and the 2022 USPSTF update recommended against initiating aspirin in adults 60 and older altogether.⁶ Despite these shifts, it is unclear how quickly prescribing practices have changed, and while aspirin’s bleeding risk is well-established in clinical trials, less is known about which real-world patient characteristics most strongly predict serious bleeding in primary prevention populations.

For the prescribing trends analysis, we examined 279 million primary care encounters that occurred between 2015 and 2025 among adults aged 40 and older. Patients with conditions that would indicate aspirin use for secondary prevention (such as coronary artery disease, prior stroke, or peripheral artery disease) as well as those for whom aspirin was contraindicated due to allergy or pregnancy were excluded.

The share of visits where low-dose aspirin appeared on the medication list fell from a peak of 7.4% in mid-2018 to 3.2% by the end of 2025, a reduction of more than half. The decline has been steady since 2018, and the downward trend was consistent across all demographic subgroups. Notably, adults aged 80 and older, the group current guidelines most strongly recommend against starting on aspirin, still had the highest prevalence at 5.7% in late 2025, down from a peak of 10.9%.

Figure 1. Low-dose aspirin prevalence rates among adults aged 40+ without a secondary prevention indication. See interactive web version for additional demographic group breakouts.

For the bleeding risk analysis, we studied 625,742 patients aged 40 and older who received their first prescription for daily low-dose aspirin between 2017 and 2025, excluding those with a prior bleeding diagnosis, secondary prevention indications, or pregnancy. To isolate the effect of aspirin itself on bleeding, we needed a comparison group that was similar in health profile but not taking aspirin. We matched aspirin-prescribed patients with those who had an allergy to aspirin documented, a group unlikely to be using aspirin. Matching was based on demographics, start year, comorbidities, and ulcer medication use.

Aspirin’s association with major bleeding was concentrated in adults 75 and older, consistent with findings from earlier clinical trials.^2,3,4 Patients aged 75–79 who used aspirin had a 33% higher risk of major bleeding compared to same-aged patients with a documented aspirin allergy, and those aged 80 and above had a 37% higher risk. For adults under 75, there was no significant difference in bleeding risk between aspirin users and those with an allergy to aspirin.

Figure 2. The likelihood of a patient experiencing a major bleeding event on low-dose aspirin compared to those with an aspirin allergy.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 2,000 hospitals and more than 47,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientist. The two teams came to similar conclusions. Graphics by Brian Olson.

Bibbins-Domingo K; US Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(12):836-845. doi:10.7326/M16-0577
Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036-1046. doi:10.1016/S0140-6736(18)31924-X
ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529-1539. doi:10.1056/NEJMoa1804988
McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509-1518. doi:10.1056/NEJMoa1805819
Arnett DK, Blumenthal RS, Gersh B, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
Davidson KW, Barry MJ, Mangione CM, et al. Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement. JAMA. 2022;327(16):1577-1584. doi:10.1001/jama.2022.4983

Once-Daily Antihypertensive Dosing Associated with Better Blood Pressure Control Than Multi-Dose Regimens for Most Medication Classes

Kersten Bartelt, RN; Eric Barkley ; Jeff Trinkl, MD; Nicholas Volker — Tue, 14 Apr 2026 11:00:00 +0000

Hypertension affects nearly half of U.S. adults and remains poorly controlled in many cases, which increases cardiovascular risk and healthcare costs.¹ Medication adherence is a critical factor in achieving blood pressure control, and dosing frequency is a known driver of adherence. Studies have demonstrated that patients are significantly more adherent to once-daily cardiovascular medications compared to twice-daily dosing.^2,3 However, the relationship between dosing frequency and blood pressure outcomes by antihypertensive medication class is less understood. We aimed to understand whether the association between dosing frequency and blood pressure control varied across the four major first-line antihypertensive classes: ACE inhibitors, ARBs, calcium channel blockers, and beta blockers.

We studied more than 1 million adults newly treated for essential hypertension between January 1, 2017, and June 30, 2025, after a series of elevated blood pressure readings. We excluded patients with secondary hypertension, those who were pregnant, and those with prior antihypertensive medication use. We compared the likelihood of achieving controlled blood pressure (systolic blood pressure at or below 140 mmHg) at 30 to 59 days, 60 to 89 days, and 90 to 180 days between patients prescribed once-daily versus multi-dose regimens. We accounted for demographics, social vulnerability based on most recent ZIP code, and baseline systolic blood pressure.

Once-daily dosing regimens were most common across all four antihypertensive classes, as shown in Figure 1. Multi-daily dosing accounted for just over 1% of ACE inhibitor, ARB, and calcium channel blocker prescriptions, but 23.8% of beta blocker prescriptions.

Figure 1. The percentage of prescriptions of each category prescribed once daily or multiple times per day.

Among patients prescribed ACE inhibitors, ARBs, and calcium channel blockers, those on once-daily regimens were more likely to achieve blood pressure control compared to multiple-dose regimens of the same medication classes. These differences emerged as early as 30 days after the prescription started and persisted through 180 days, as seen in Figure 2. In contrast, beta blockers showed a decrease in early blood pressure control when prescribed once per day, though there was no significant difference at 90 to 180 days.

Figure 2. The likelihood of a patient’s systolic BP being ≤ 140 mmHg on once-daily dosing compared to multiple doses per day by medication class.

Multi-dose prescribing for newly hypertensive patients is uncommon among most of the medications studied. The patients who did receive multi-dose regimens might have other factors that influenced the prescribing pattern that were not accounted for. Observed associations represent prescribing patterns rather than confirmed medication exposure or use.

Lee JS, Segura Escano R, Therrien NL, et al. Antihypertensive Medication Adherence and Medical Costs, Health Care Use, and Labor Productivity Among People With Hypertension. J Am Heart Assoc. 2024;13(21):e037357. doi:10.1161/JAHA.124.037357
Srivastava K, Arora A, Kataria A, Cappelleri JC, Sadosky A, Peterson AM. Impact of reducing dosing frequency on adherence to oral therapies: a literature review and meta-analysis. Patient Prefer Adherence. 2013;7:419-434. Published 2013 May 20. doi:10.2147/PPA.S44646
Laliberté F, Bookhart BK, Nelson WW, et al. Impact of once-daily versus twice-daily dosing frequency on adherence to chronic medications among patients with venous thromboembolism. Patient. 2013;6(3):213-224. doi:10.1007/s40271-013-0020-5

Emergency Departments Now Handle Nearly Half of RSV Encounters as Hospitalizations and ICU Admissions Decline

Kersten Bartelt, RN; Joe Deckert, PhD; Blaine Franklin, PT, DPT; Eric Barkley — Thu, 09 Apr 2026 11:00:00 +0000

Respiratory syncytial virus (RSV) is a common respiratory infection that causes cold-like symptoms in most people but can lead to serious illness, including pneumonia and bronchiolitis, in infants, young children, and older adults.¹ RSV typically follows a seasonal pattern, rising in the fall and peaking in the winter months.^2,3 The COVID-19 pandemic disrupted these patterns significantly: RSV activity was extremely low during the 2020–2021 season, returned off-season in summer 2021, and then surged to historically high levels during the 2022–2023 winter.^4,5 In 2023, the FDA approved the first RSV vaccines for older adults and for use during pregnancy to protect infants, opening a new era of RSV prevention.^6,7,8,9 While much attention has focused on the changing volume of RSV cases, less is known about how the severity distribution of RSV encounters across care settings has evolved. Understanding whether the share of RSV cases requiring ICU admission or hospitalization has changed over time, and how these patterns differ by age, can help healthcare systems plan resource allocation and inform ongoing prevention strategies.

We studied 2 million U.S. patients who sought medical care for RSV between January 2017 and January 2026. For each patient encounter, we classified the highest level of care into four mutually exclusive categories: ICU admission, hospital admission, emergency department (ED) visit, or office visit. This acuity distribution was computed for the overall population and stratified by age group: under 2, 2–4, 5–17, 18–49, 50–64, 65–74, and 75 years and older.

The distribution of RSV encounters across care settings has shifted markedly over the past nine years. In January 2017, 8.2% of RSV encounters resulted in ICU admission, 21.9% in hospital admission, 29.4% in ED visits, and 40.6% in office visits, as seen in Figure 1. By January 2026, those proportions had shifted to 3.8% ICU, 11.8% admission, 45.0% ED, and 39.4% office visits. Notably, the office visit share remained relatively steady throughout the study period (40.6% in January 2017 and 39.4% in January 2026) indicating that the shift toward ED care came primarily from hospitalizations and ICU admissions, not from patients who would otherwise have been seen in outpatient settings. This lower-acuity pattern began during the COVID-19 pandemic and has persisted through subsequent seasons.

We additionally looked at this distribution by age group. Among adults aged 75 and older, hospitalizations and ICU admissions accounted for 79.0% of RSV encounters in January 2017 but fell to 47.2% by January 2026. The ED share in this group more than tripled over that period, growing from 6.9% to 24.6%. Adults aged 65–74 followed a similar trajectory. For children under 2 years old, ICU admissions declined from 7.4% of cases in January 2017 to 3.8% in January 2026, and ED visits grew from 31.2% to 47.6%. Children aged 2–4 had a similar pattern. School-aged children (ages 5–17) saw the largest proportional decline in inpatient care: their combined hospitalization and ICU share fell from 37.3% in January 2017 to 6.0% in January 2026.

Figure 1. The distribution of the highest level of care reached among patients with RSV.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 2,000 hospitals and more than 47,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

About RSV. U.S. Centers for Disease Control and Prevention. December 30, 2025. https://www.cdc.gov/rsv/about/index.html. Accessed March 2, 2026.
Hamid S, Winn A, Parikh R, et al. Seasonality of Respiratory Syncytial Virus – United States, 2017-2023. MMWR Morb Mortal Wkly Rep. 2023;72(14):355-361. Published 2023 Apr 7. doi:10.15585/mmwr.mm7214a1
Agha R, Avner JR. Delayed Seasonal RSV Surge Observed During the COVID-19 Pandemic. Pediatrics. 2021;148(3):e2021052089. doi:10.1542/peds.2021-052089
Butler S, Barkley E. RSV Rebounds Off-Season, but Influenza Is Still a No-Show. Epic Research. https://epicresearch.org/articles/rsv-rebounds-off-season-but-influenza-is-still-a-no-show. Accessed March 2, 2026.
Rios-Guzman E, Simons LM, Dean TJ, et al. Deviations in RSV epidemiological patterns and population structures in the United States following the COVID-19 pandemic. Nat Commun. 2024;15(1):3374. Published 2024 Apr 20. doi:10.1038/s41467-024-47757-9
FDA approves first respiratory syncytial virus (RSV) vaccine. U.S. Food and Drug Administration. May 4, 2023. Accessed December 26, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine. Accessed March 2, 2026.
Bartelt K, Deckert J, Gracianette M, Barkley E. RSV Vaccine Can Prevent More Than 70% of RSV Infections, ED Visits, and Admissions Among Older Adults. Epic Research. https://epicresearch.org/articles/rsv-vaccine-can-prevent-more-than-70-of-rsv-infections-ed-visits-and-admissions-among-older-adults. Accessed on April 6, 2026.
FDA approves first vaccine for pregnant individuals to prevent RSV in infants. U.S. Food and Drug Administration. Published August 21, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants. Accessed March 2, 2026.
Bartelt K, Gasser J, Higgs E, Gracianette M, Barkley E. Maternal RSV Vaccine Effective in Reducing RSV Infections and Hospitalizations in Infants. Epic Research. https://epicresearch.org/articles/maternal-rsv-vaccine-effective-in-reducing-rsv-infections-and-hospitalizations-in-infants. Accessed on April 6, 2026.

At-Home Nasal Flu Vaccine Associated with Lower Influenza Infection Rates Than In-Clinic Nasal Vaccine

Thu, 26 Mar 2026 11:00:00 +0000

In September 2024, the FDA approved FluMist, the only nasal spray influenza vaccine for self-administration.¹ AstraZeneca launched FluMist Home in August 2025, offering home delivery in 34 states for the 2025/2026 season.² This at-home option is intended to improve vaccination access by removing logistical barriers such as clinic scheduling and needle aversion. FluMist is a live attenuated influenza vaccine (LAIV) approved for people ages 2 through 49, meaning it uses weakened live viruses administered through the nose rather than the inactivated virus delivered by injection. Understanding of the real-world efficacy of the at-home version remains limited.

We studied 10,260 patients aged 2 and older who received an influenza vaccine between August 1, 2025, and January 31, 2026, and who resided in one of the 34 states where the at-home nasal influenza vaccine was available. Patients were classified by whether they received the nasal vaccine at home or in clinic. We matched patients on vaccination month, race and ethnicity, and age. We additionally accounted for sex, social vulnerability and rurality based on most recent address, prior-year healthcare utilization, BMI classification, pregnancy status, and comorbidities.

We found that patients who received the at-home nasal vaccine were 37.4% less likely to be diagnosed with an influenza infection during the 2025/2026 influenza season compared to those who received the in-clinic nasal vaccine, as seen in Figure 1.

Figure 1. The likelihood of a patient being diagnosed with influenza after a nasal influenza vaccination by administration setting.

The unadjusted infection rate was 1.1% among the at-home vaccinated group compared to 1.7% among the in-clinic vaccinated group. While this difference favors the at-home group, its interpretation requires careful consideration of how the two populations differ. Both groups received the same vaccine; the difference lies in the setting of administration. As such, similar effectiveness would be expected, and the difference might indicate that there are meaningful differences between the populations that matching and adjustment were not able to fully account for.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,900 hospitals and more than 45,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientist. The two teams came to similar conclusions. Graphics by Brian Olson.

US Food and Drug Administration. FDA approves nasal spray influenza vaccine for self- or caregiver-administration. FDA. Published September 20, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-nasal-spray-influenza-vaccine-self-or-caregiver-administration. Accessed February 26, 2026.
AstraZeneca. FLUMIST, the nation’s only nasal spray flu vaccine, now available for home delivery. Published August 15, 2025. https://www.astrazeneca-us.com/media/press-releases/2025/FLUMIST-the-nations-only-nasal-spray-flu-vaccine-now-available-for-home-delivery.html. Accessed February 24, 2026.

GLP-1 Use Associated with Lower Osteoporosis Risk in Adults with Type 2 Diabetes but Higher Risk in Adults Without Diabetes

Tue, 03 Mar 2026 12:00:00 +0000

Weight loss can be beneficial for overall health; however, studies have shown weight loss can compromise bone density and bone strength.¹ This concern is especially relevant with the growing use of GLP-1 medications, which are effective for both diabetes glycemic control and obesity management. While prior research has shown GLP-1s influence bone metabolism,^2,3 the degree to which they alter the osteoporosis risk associated with weight loss remains less clear. We aimed to assess the relationship between GLP-1s and osteoporosis likelihood across different amounts of weight change among patients with and without diabetes.

First, we studied 2 million patients diagnosed with type 2 diabetes who had a healthcare encounter between January 1, 2017, and October 31, 2024. Patients with type 2 diabetes who were prescribed a GLP-1 were compared to those who have never been on a GLP-1 medication. We accounted for age, sex, BMI, smoking history, chronic steroid usage, and weight change over time.

For patients with type 2 diabetes who maintained a stable weight, GLP-1 use was associated with an 8.7% lower osteoporosis risk compared to patients who did not use a GLP-1, as seen in Figure 1. Among groups that lost more weight, osteoporosis risk rose for those with and without GLP-1s, but the increase in risk was consistently smaller among GLP-1 users. Weight gain was associated with increased osteoporosis risk among those not on a GLP-1, while weight gain was not associated with statistically significant change in osteoporosis risk for those on a GLP-1.

Figure 1. The likelihood of osteoporosis among patients with type 2 diabetes by GLP-1 usage and weight change.

Next, we studied 380,438 patients without diabetes who were prescribed a GLP-1 or other weight loss medication and who had a visit between January 1, 2017, and October 31, 2024. Patients who were prescribed a GLP-1 were compared to those prescribed a different type of weight loss medication. Like the above analysis, we accounted for age, sex, BMI, smoking history, chronic steroid usage, and weight change over time.

Among patients without diabetes, the pattern differed from patients with type 2 diabetes: patients on a GLP-1 who maintained a stable weight had a higher osteoporosis risk relative to those who maintained a stable weight on another weight loss medication (22.0% higher for GLP-1 users). With increasing weight loss, osteoporosis risk increased in both groups, and the GLP-1 risks were generally similar to or higher than the non-GLP-1 weight loss medication risks. Weight gain among patients without diabetes was associated with increased osteoporosis risk in both groups.

Figure 2. The likelihood of osteoporosis among patients without diabetes by GLP-1 use and weight change.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,900 hospitals and more than 42,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists, in collaboration with a researcher from Johns Hopkins. The two teams came to similar conclusions. Graphics by Brian Olson.

Paccou J, Compston JE. Bone health in adults with obesity before and after interventions to promote weight loss. Lancet Diabetes Endocrinol. 2024;12(10):748-760. doi:10.1016/S2213-8587(24)00163-3
Cai TT, Li HQ, Jiang LL, et al. Effects of GLP-1 Receptor Agonists on Bone Mineral Density in Patients with Type 2 Diabetes Mellitus: A 52-Week Clinical Study. Biomed Res Int. 2021;2021:3361309. Published 2021 Sep 17. doi:10.1155/2021/3361309
Tan Y, Liu S, Tang Q. Effect of GLP-1 receptor agonists on bone mineral density, bone metabolism markers, and fracture risk in type 2 diabetes: a systematic review and meta-analysis. Acta Diabetol. 2025;62(5):589-606. doi:10.1007/s00592-025-02468-5

Fentanyl Testing Associated with Short-Term Survival Benefits; Increased Long-Term Mortality Risk Among Overdose Patients

Thu, 26 Feb 2026 12:00:00 +0000

Opioid misuse continues to pose a critical public health issue in the United States, particularly due to the increasing prevalence of synthetic opioids such as fentanyl.¹ Efforts to curb this epidemic have been implemented, such as increased fentanyl screening and increasing access to naloxone².However, questions remain about whether fentanyl testing during ED encounters is associated with subsequent treatment and survival.

To understand trends in overdose visits, we studied more than 230 million ED visits between January 2018 and November 2025. We studied overall overdoses, overdoses from opioids, and overdoses from synthetic opioids, each a subset of the preceding broader category.

The 12-month rolling average rate of ED visits for all types of overdoses peaked at 946 per 100,000 in March 2021, a period when overall ED volumes were unusually low, as seen in Figure 1.³ By November 2025, the rate had declined to 634 per 100,000, reflecting a 33% decline and falling below pre-pandemic levels. Opioid overdoses followed a similar trajectory, with rates trending downward after naloxone became available over the counter in 2023.² In contrast, synthetic opioid overdoses increased more than threefold from 15 to 51 per 100,000 visits between December 2018 and November 2025, though rates have declined after peaking at 66 per 100,000 in December 2023. Notably, testing for synthetic opioids also increased by more than 400% from the first quarter of 2021 to the fourth quarter of 2025, as seen on the Epic Research Fentanyl and Opiate Toxicology data tracker.⁴

Figure 1. The 12-month rolling average rate of ED visits for any overdose, opioid overdose, and synthetic opioid overdose.

There has been a rise in the incidence of synthetic opioid overdose mortality cases since 2018,⁵ picking up in 2020 and reaching a peak of 77,695 cases in June 2023, according to the U.S. Centers for Disease Control and Prevention (CDC), as seen in Figure 2. Since then, the number of synthetic opioid overdose deaths has declined substantially, reaching a low of 38,514 cases in August 2025, a reduction of more than 50% from the peak.

Figure 2. The rate of synthetic opioid overdose deaths for the previous 12 months based on data from the CDC.

To understand the relationship between fentanyl testing and outcomes such as mortality and repeat overdose encounters, we studied more than 1 million patients who had a non-fatal ED visit for an overdose. We accounted for demographics, social vulnerability and rurality based on most recently documented address, count of prior overdose encounters, administration of naloxone during the ED visit, and ED acuity score.

Among patients who were tested for fentanyl, the likelihood of being prescribed a medication for opioid use disorder (MOUD) during the encounter was 147% higher compared to those who were not tested for fentanyl, as seen in Figure 3. Short term outcomes were also improved: the likelihood of death within 30 days was 11% lower. There was not a significant difference in the likelihood of a repeat ED visit for an overdose within 30 days between patients who had fentanyl testing and those who did not. The likelihood of mortality or a repeat overdose within one year was higher among those who had fentanyl testing than those who were not tested. This pattern might reflect that patients who receive fentanyl testing represent a higher-risk population with more severe substance use disorders.

Figure 3. The likelihood of mortality, subsequent overdose, or MOUD treatment by whether the patient was tested for fentanyl during an overdose encounter.

Importantly, fentanyl testing might indicate clinical suspicion or resource availability. Indications for testing patients for fentanyl might include additional considerations we were not able to fully assess as part of this analysis.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,900 hospitals and more than 42,000 clinics from all 50 U.S. states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

Pickens CM, Park J, Casillas SM, et al. Trends in Suspected Fentanyl-Involved Nonfatal Overdose Emergency Department Visits, by Age Group, Sex, and Race and Ethnicity – United States, October 2020-March 2024. MMWR Morb Mortal Wkly Rep. 2025;74(16):282-287. Published 2025 May 8. doi:10.15585/mmwr.mm7416a2
Emergent BioSolutions’ NARCAN® Nasal Spray Launches Over the Counter Making it Possible for Everyone to Help Save a Life from an Opioid Overdose Emergency. Emergent BioSolutions. August 30, 2023. https://investors.emergentbiosolutions.com/news-releases/news-release-details/emergent-biosolutions-narcanr-nasal-spray-launches-over-counter. Accessed January 12, 2026.
Noel A, Alban C, Trinkl J et al. Fewer Visits, Sicker Patients: The Changing Character of Emergency Department Visits During the COVID-19 Pandemic. Epic Research. https://epicresearch.org/articles/fewer-visits-sicker-patients-the-changing-character-of-emergency-department-visits-during-the-covid-19-pandemic. Accessed on August 11, 2025.
Fentanyl and Opiate Toxicology in Emergency Department Overdoses. Epic Research. https://www.epicresearch.org/data-tracker/fentanyl-and-opiate-toxicology. Accessed August 26, 2025.
Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2025. DOI: https://dx.doi.org/10.15620/cdc/20250305008

Influenza Visits Peak Higher This Season, Especially Among Children and Older Adults

Taylor Kirby — Tue, 24 Feb 2026 13:45:00 +0000

Seasonal influenza places a significant burden on healthcare systems each year, and the timing, intensity, and age distribution of flu seasons can vary considerably.¹ Understanding how influenza affects different age groups helps inform vaccination campaigns, clinical preparedness, and public health messaging.

To increase understanding of age-group-specific trends in influenza and other communicable diseases, we updated the Communicable Diseases Data Tracker to include age group breakdowns: under 2, 2–4, 5–17, 18–49, 50–64, and 65 and older. The data tracker shows weekly rates of communicable disease diagnoses or positive labs per 100,000 patients with office visits, emergency department visits, or admissions across more than 300 healthcare organizations.

This season’s influenza peak was notably higher than the prior two seasons, but the increase was not evenly distributed across age groups. Children and older adults saw the sharpest rise, while middle-aged adults were largely unaffected. Among all age groups, children experienced the highest peak visit rates, rising to 90% higher than the 2023–24 season. Adults aged 65 and older also saw a marked increase, with peak rates 56% above the 2023–24 season. By contrast, adults aged 50–64 showed virtually no change across all three seasons, and adults aged 18–49 saw only a moderate increase.

Figure 1. Peak influenza visit rates per 100,000 patients by age group since the 2023–24 flu season.

Hu T, Miles AC, Pond T, et al. Economic burden and secondary complications of influenza-related hospitalization among adults in the US: a retrospective cohort study. J Med Econ. 2024;27(1):324-336. doi:10.1080/13696998.2024.2314429

“Lean MASLD” Typically Clustered Near Obese BMI Threshold

Kersten Bartelt, RN; Eric Barkley; Louis Kazaglis, MD; Jacob Gasser — Thu, 19 Feb 2026 12:00:00 +0000

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is the most common chronic liver disease worldwide, affecting an estimated one in four U.S. adults.¹ Although MASLD is closely associated with obesity, the disease also occurs in individuals without obesity, a phenomenon known as “lean MASLD”.²

To better understand factors that influence MASLD, particularly those at non-obese BMIs, we studied 190,335 patients diagnosed with MASLD between ages 45 and 64 who did not have hepatitis, alcohol-related disorders, amputations, or tamoxifen exposure. Patients were categorized into six BMI groups based on their BMI measurement in the year prior to their diagnosis: underweight (<18.5), healthy weight (18.5–24.9), overweight-low (25.0–27.4), overweight-high (27.5–29.9), class 1—2 obesity (30.0–39.9), and class 3 obesity (40+).

We found that most patients diagnosed with MASLD (79.1%) had an obese BMI. Among non-obese patients, MASLD was most common in the overweight range and least common in underweight and healthy weight categories. This pattern suggests that excess weight is a risk factor for MASLD even among patients who are not clinically obese.

Figure 1. The BMI distribution among non-obese patients aged 45–64 with MASLD

While BMI is a primary risk factor in the development of MASLD, we examined whether additional conditions were correlated with MASLD. Circulatory disorders increased substantially from underweight to severe obesity (47.5% to 81.9%), and endocrine disorders were highly prevalent across all BMI groups and increased further with an increase in BMI (79.2% to 95.6%), consistent with a growing cardiometabolic burden as BMI rises among patients with MASLD.

In contrast, underweight patients exhibited a distinct profile, including the highest rates of blood disorders (41.7%), which suggests this subgroup might differ meaningfully from higher-BMI MASLD patients and might warrant closer attention to other factors.

Figure 2. The prevalence of condition groups among patients aged 45–64 with MASLD by their BMI classification.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 42,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

Sheth SG, Chopra S. Clinical features and diagnosis of metabolic dysfunction-associated steatotic liver disease (nonalcoholic fatty liver disease) in adults. UpToDate. March 7, 2025. https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-metabolic-dysfunction-associated-steatotic-liver-disease-nonalcoholic-fatty-liver-disease-in-adults. Accessed August 27, 2025.
Rotaru A, Stratina E, Huiban L, et al. Beyond BMI: revealing metabolic risk in lean MASLD. Arch Clin Cases. 2025;12(3):110-118. Published 2025 Aug 4. doi:10.22551/2025.48.1203.10322

Telehealth Use for Primary Care Visits Has Stabilized, with Higher Use in Metropolitan Areas and Among Non-English Speakers

Kersten Bartelt, RN; Emily Higgs ; Louis Kazaglis, MD; Eric Barkley — Tue, 17 Feb 2026 12:00:00 +0000

Telehealth use in the United States expanded rapidly during the COVID-19 pandemic, supported by temporary federal and commercial coverage flexibilities that allowed virtual care to substitute for in-person visits across primary care and many specialties.¹ Since then, telehealth use has declined across all specialties,² with mental health care retaining the highest proportion of visits conducted by telehealth.³ Policy discussions now focus on which flexibilities should be made permanent and how telehealth affects access and equity, particularly across different populations.⁴ Understanding how telehealth has trended in the post-acute pandemic period and how patterns differ by geography, age, and preferred language can inform operational planning, interpreter services, and policy decisions.

We studied 411 million primary care visits between July 2022 and October 2025. For each encounter, we identified the patient’s rurality based on their most recent ZIP Code, their age at the time of the encounter, and their preferred language. We evaluated each subgroup for the proportion of primary care they had conducted by telehealth.

Across all primary care encounters, telehealth use declined from mid-2022 to mid-2023 and then stabilized at around 6% of visits. Telehealth accounted for just over 8% of encounters in July 2022 and just under 6% by October 2025, representing a roughly 30% reduction by the end of the study period. Since 2023, the overall telehealth share has remained around 6–7%, suggesting a new steady state in the balance between virtual and in-person care.

Telehealth remained more common for patients from metropolitan areas than for those from less urban settings throughout the study period, as seen in Figure 1. While the telehealth proportion fell in all rurality categories, the relative urban–rural gradient persisted: metropolitan patients consistently had about twice the telehealth rate of patients in rural or small-town areas, with micropolitan areas in between.

Figure 1. The 12-month rolling average percent of primary care visits that were conducted using telehealth by patient’s rurality.

Age patterns were stable over time, with telehealth concentrated among working-age adults and less frequently used for very young children and the oldest adults. Children aged 0–2 years consistently had telehealth shares below 2%, while adults aged 25–39 years had rates above 10% across the study window.

Figure 2. The 12-month rolling average percent of visits in primary care that were conducted using telehealth by patient’s age.

Telehealth use was consistently higher among patients whose preferred language was not English, and this pattern persisted despite overall declines, as seen in Figure 3. Chinese-, Portuguese-, Russian-, Persian-, and Spanish-speaking patients started from substantially higher baseline telehealth rates, and those rates remained substantially higher than those of English speakers by the end of the study period.

Figure 3. The 12-month rolling average percent of primary care visits that were conducted using telehealth by patient’s preferred language.

Shaver J. The State of Telehealth Before and After the COVID-19 Pandemic. Prim Care. 2022;49(4):517-530. doi:10.1016/j.pop.2022.04.002
Bartelt K, Piff A, Allen S, Barkley E. Telehealth Utilization Higher Than Pre-Pandemic Levels, but Down from Pandemic Highs. Epic Research. https://epicresearch.org/articles/telehealth-utilization-higher-than-pre-pandemic-levels-but-down-from-pandemic-highs. Accessed on December 17, 2025.
Telehealth Utilization. Epic Research. https://www.epicresearch.org/data-tracker/telehealth-trending. Accessed December 17, 2025.
Telehealth policy updates. Health Resources & Services Administration. November 21, 2025. https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates. Accessed on December 17, 2025.

Prostate Cancer Screening and Diagnosis Rates Up for 55–84-Year-Old Men

Taylor Kirby — Thu, 12 Feb 2026 12:00:00 +0000

Prostate cancer is the second most common cancer among men in the United States and is most common in older men.¹ Prostate-specific antigen (PSA) blood testing can be used as a screening tool to identify patients at high risk of developing prostate cancer.²However, PSA-based screening is not standardly recommended for all men: the U.S. Preventive Services Task Force (USPSTF) recommends shared clinical decision-making between a physician and the patient to determine whether PSA screening should be performed.³

Our Epic Research Cancer Incidence Data Tracker tracks the rate of new prostate cancer diagnoses and PSA screenings each quarter over the past four years. The rates are stratified by age to better understand trends across different demographic groups.

Quarterly PSA screening rates increased across all age groups assessed between Q1 2021 and Q4 2025. Screening among men ages 55–64 increased the most over this period, increasing nearly 50% from 6,497.3 screenings per 100,000 encounters to 9,696.0 screenings per 100,000 encounters.

Figure 1. PSA prostate cancer screening rates by quarter from 2021 to 2025.

Over the same period, the rate of new prostate cancer diagnoses increased for men aged 55–64, 65–74, and 75–84, whose rate of new prostate cancer diagnoses increased 22%, 15%, and 12%, respectively.

Figure 2. New prostate cancer diagnosis rates by quarter from 2021 to 2025.

You can stay up to date on the latest trends in cancer diagnoses and screenings with our Epic Research data tracker.

American Cancer Society. Key Statistics for Prostate Cancer | Prostate Cancer Facts. www.cancer.org. Published January 19, 2024. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
‌American Cancer Society. Prostate cancer screening tests. www.cancer.org. Published 2023. https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/tests.html
‌ USPSTF. Recommendation: Prostate Cancer: Screening | United States Preventive Services Taskforce. www.uspreventiveservicestaskforce.org. Published 2018. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening