Epic Research

Blood Clot Risk Influenced by Hormone Therapy Administration Route in Women 50 and Older

Wed, 23 Apr 2025 11:00:00 +0000

Hormone replacement therapy (HRT) is widely prescribed for postmenopausal women to alleviate symptoms and mitigate long-term health risks.¹ However, concerns about increased risk of blood clotting disorders have been raised, particularly regarding different routes of administration.² Prior studies suggest that oral estrogen might pose a greater risk for venous thromboembolism compared to transdermal estrogen, often applied as a patch or gel on the skin.²^,3,4

To understand the real-world risk of blood clot disorders for women on HRT by route of administration, we studied 1,429,074 women aged 50 and older who initiated HRT between January 1, 2018, and March 1, 2023, and used only one HRT administration route during the study period. We studied injection, oral, transdermal, and vaginal administration routes. Patients who received their HRT vaginally were used as the baseline comparison group. We also factored in patient demographics, BMI, smoking status, and comorbid medical conditions, such as history of clots, hyperlipidemia, and cancer.

Women who were prescribed transdermal HRT were 22% less likely to have an ischemic stroke, 25% less likely to have a thromboembolism, 26% less likely to have a myocardial infarction (MI), and 27% less likely to have a pulmonary embolism (PE) compared to those who received their HRT vaginally. Women prescribed oral HRT were 26% more likely to have an arterial clot but 7% less likely to have a stroke compared to those who received their HRT vaginally. We did not observe a difference in the likelihood of clotting disorders between injectable HRT and HRT administered vaginally.

Figure 1. The likelihood of a woman experiencing a clot disorder by HRT route.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 298 million patient records from 1,700 hospitals and more than 39,000 clinics from all 50 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.

Hormone replacement therapy (HRT) for menopause. Cleveland Clinic. March 12, 2024. https://my.clevelandclinic.org/health/treatments/15245-hormone-therapy-for-menopause-symptoms. Accessed March 14, 2025.
Postmenopausal estrogen therapy: route of administration and risk of venous thromboembolism. Committee Opinion No. 556. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 121:887–90
Canonico M, Oger E, Plu-Bureau G, et al. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation. 2007;115(7):840-845. doi:10.1161/CIRCULATIONAHA.106.642280
LaVasseur C, Neukam S, Kartika T, Samuelson Bannow B, Shatzel J, DeLoughery TG. Hormonal therapies and venous thrombosis: Considerations for prevention and management. Res Pract Thromb Haemost. 2022;6(6):e12763. Published 2022 Aug 23. doi:10.1002/rth2.12763

One in Four Patients with Severely Elevated Cholesterol Have No Documented Lipid-Lowering Medication

Wed, 16 Apr 2025 11:00:00 +0000

Statins are a commonly recommended lipid-lowering therapy for the prevention of atherosclerotic cardiovascular disease (ASCVD), particularly for patients with severe hyperlipidemia, also known as high cholesterol, defined as an LDL cholesterol test of 190 mg/dL or greater.¹ Guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend high-intensity statins for all adults with an LDL level of 190 mg/dL or higher to reduce the risk of cardiovascular events.¹ Despite these clear recommendations, use of statin therapy remains much lower than recommended, with prior studies showing that less than 50% of eligible patients receive appropriate lipid-lowering treatment.²

To understand how clinical practice compared to the guidelines for lipid-lowering medication prescribing in recent years, we studied 763,498 patients with an LDL test result of 190 mg/dL or higher between January 1, 2019, and February 12, 2023, and an outpatient visit at least two years later. We grouped patients by the type of lipid-lowering medication they had documented before or within two years following their LDL test.

We found that 25.1% of patients did not have any lipid-lowering medications documented, as seen in Figure 1. Lipid-lowering medication documentation was particularly low among younger adults, with 46.2% of those aged 18 to 39 not having one documented, compared to 22.8% in those aged 40 to 74 and 18.0% in those aged 75+. Statins were the most common type of lipid-lowering medication documented.

Figure 1. The rate of patients with an LDL ≥190 mg/dL and a lipid-lowering medication documented by age.

Next, we evaluated lipid-lowering medication rates in patients who were at increased risk for cardiovascular events. We found that those with a history of MI, stroke, or type 2 diabetes had the lowest rates of no lipid-lowering medications at 3.4%, 7.1%, and 9.2%, respectively. Patients with familial hyperlipidemia had lipid-lowering medications documented more often than the overall population, at 13.8% with no documented lipid-lowering medication.

Figure 2. The rate of patients with an LDL ≥190 mg/dL and a lipid-lowering medication documented by increased cardiovascular risk factor.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,700 hospitals and more than 39,000 clinics from all 50 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.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Jun 18;139(25):e1182-e1186. doi: 10.1161/CIR.0000000000000698.] [published correction appears in Circulation. 2023 Aug 15;148(7):e5. doi: 10.1161/CIR.0000000000001172.]. Circulation. 2019;139(25):e1082-e1143. doi:10.1161/CIR.0000000000000625
Navar AM, Wang TY, Li S, et al. Lipid Management in Contemporary Community Practice: Results from the Provider Assessment of Lipid Management (PALM) Registry. Am Heart J. 2017;193:84-92. doi:10.1016/j.ahj.2017.08.005.

No Correlation Between Ketamine Administered on Day of Surgery and Neurological Complications for Traumatic Brain Injury Patients

Tony Dunnigan, MD; Joe Deckert, PhD; Kersten Bartelt, RN; Eric Barkley — Tue, 01 Apr 2025 11:00:00 +0000

Traumatic brain injury (TBI) is a type of brain damage caused by an external force, such as an impact or penetrating injury to the head.¹ Severe cases can result in death or long-term neurological impairment.² Ketamine is sometimes used in patients with TBIs to maintain blood pressure, control agitation or seizures, or as a sedative.³^,4 However, there have been previous concerns that ketamine might raise intracranial pressure, which could be detrimental to patients with TBIs.^4,5 This study aimed to evaluate the relationship between ketamine administration during hospitalization for surgically treated TBI and in-hospital death or severe neurological impairment.

We studied 21,888 adult patients who underwent surgical treatment for TBI, such as a craniotomy, hematoma evacuation, or skull fracture repair, between 2010 and 2025 and compared outcomes for patients who received ketamine on the same day as their surgery and those who did not. We accounted for patient age, sex, race, ethnicity, socioeconomic vulnerability, TBI category, and emergency department acuity level.

We found no significant difference in the likelihood of developing paralysis, seizures, or attention deficit disorder in the six months following surgery, and no significant difference in the likelihood of in-hospital death between patients who received ketamine on the day of surgery and those who did not.

Figure 1. The likelihood of a patient with a TBI experiencing severe neurological complications by ketamine administration on the day of surgery. Confidence intervals that cross the baseline likelihood indicate that the observed change in likelihood might be due to random chance.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 39,000 clinics from all 50 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.

Facts about TBI. U.S. Centers for Disease Control and Prevention. June 18, 2024. https://www.cdc.gov/traumatic-brain-injury/data-research/facts-stats/index.html. Accessed February 13, 2025.
Maas AIR, Menon DK, Adelson PD, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987-1048. doi:10.1016/s1474-4422(17)30371-x
Richards ND, Howell SJ, Bellamy MC, Beck J. The diverse effects of ketamine, jack-of-all-trades: a narrative review. Br J Anaesth. 2025;134(3):649-661. doi:10.1016/j.bja.2024.11.018
Godoy DA, Badenes R, Pelosi P, Robba C. Ketamine in acute phase of severe traumatic brain injury “an old drug for new uses?” Crit Care. 2021;25(1). doi:10.1186/s13054-020-03452-x
Zanza C, Piccolella F, Racca F, et al. Ketamine in Acute Brain Injury: Current Opinion Following Cerebral Circulation and Electrical Activity. Healthcare (Basel). 2022;10(3):566. Published 2022 Mar 17. doi:10.3390/healthcare10030566

Hurricanes Have Minimal Influence on Sinus Infection Rates

Thu, 27 Mar 2025 11:00:00 +0000

Hurricanes have been associated with a range of public health concerns, including respiratory illnesses due to mold exposure, infrastructure damage limiting healthcare access, and increased stress-related conditions.^1,2Previous studies have looked at increases in respiratory symptoms following specific hurricanes, but the overall impact of hurricanes on sinus infections remains unclear.^3,4 Anecdotal reports suggest that more patients seek care for sinus infections after a hurricane, highlighting the need for further research on this potential connection.

To assess whether hurricane-affected populations experienced an increase in sinus infections, we examined encounters for either acute or chronic sinus infections in the six-week period following landfall of hurricanes Ian (2022), Nicole (2022), Idalia (2023), and Debby (2024).⁵^–⁸ We compared these periods to the same timeframe in the year before and after each hurricane. We compared Debby to the two years prior because it was too recent to compare to the year after. Our study population included residents of affected ZIP codes in Florida, Georgia, and South Carolina who had a healthcare encounter during the relevant study period.

We found that the impact of hurricanes on sinus infection rates was minimal. Despite some minor fluctuations, we did not observe a consistent change in acute or chronic sinus infections in the weeks following any of the hurricanes studied compared to the years before and after. However, seasonal increases in sinus infection rates coincide with when hurricanes often make landfall and have a much more noticeable effect, as seen in Figures 1 and 2.

Figure 1. Five-week rolling average of seasonal acute sinus infection rates in the geographic areas affected by hurricanes Ian, Nicole, Idalia, and Debby.

Figure 2. Five-week rolling average of seasonal chronic sinus infection rates over time in the geographic areas affected by hurricanes Ian, Nicole, Idalia, and Debby.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 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.

Azimi P, Allen J. Respiratory health harms often follow flooding—taking these steps can help. Harvard Health Publishing. November 9, 2022. Accessed March 6, 2025. https://www.health.harvard.edu/blog/respiratory-health-harms-often-follow-flooding-taking-these-steps-can-help-202211092848
BiologyInsights Team. Health risks from flooding after hurricanes. BiologyInsights. January 9, 2025. Accessed March 6, 2025. https://biologyinsights.com/health-risks-from-flooding-after-hurricanes/
Rath B, Young EA, Harris A, et al. Adverse respiratory symptoms and environmental exposures among children and adolescents following Hurricane Katrina. Public Health Rep. 2011;126(6):853-860. doi:10.1177/003335491112600611
Oluyomi AO, Panthagani K, Sotelo J, et al. Houston hurricane Harvey health (Houston-3H) study: assessment of allergic symptoms and stress after hurricane Harvey flooding. Environ Health. 2021;20(1):9. Published 2021 Jan 19. doi:10.1186/s12940-021-00694-2
National Hurricane Center. Tropical Cyclone Report: Hurricane Ian. National Oceanic and Atmospheric Administration. Updated April 3, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL092022_Ian.pdf
National Hurricane Center. Tropical Cyclone Report: Hurricane Nicole. National Oceanic and Atmospheric Administration. Updated March 17, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL172022_Nicole.pdf
National Hurricane Center. Tropical Cyclone Report: Hurricane Idalia. National Oceanic and Atmospheric Administration. Updated February 13, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL102023_Idalia.pdf
National Hurricane Center. Tropical Cyclone Report: Hurricane Debby. National Oceanic and Atmospheric Administration. Updated February 4, 2025. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL042024_Debby.pdf.

Some Diabetic Complications Less Likely Among Type 1 Diabetics on GLP-1s

Tue, 25 Mar 2025 11:00:00 +0000

Type 1 diabetes (T1D) requires lifelong insulin therapy, and recent interest has emerged in the use of GLP-1 medications as an adjunct treatment.¹^,2 GLP-1s, such as semaglutide and liraglutide, are approved for type 2 diabetes to improve glycemic control and promote weight loss by enhancing insulin secretion, suppressing glucagon release, and slowing gastric emptying.³ Although they are not approved for T1D, some patients may receive them off-label or for weight control.

To better understand the relationship between GLP-1 use and diabetes-related outcomes in patients with T1D, we compared 7,010 adult patients with T1D who were prescribed GLP-1s and insulin to 304,422 adult patients with T1D who were on insulin alone.

After taking into account patient demographics, BMI, HbA1c, smoking history, and hypertension, we found that patients with T1D who had no history of the given complication who used a GLP-1 medication were 55% less likely to have a hyperglycemia-related ED visit, 29% less likely to have a diabetic ketoacidosis (DKA)-related ED visit, and 26% less likely to have an amputation-related visit compared to those on insulin alone, as seen in Figure 1. While we saw some decrease in the rate of ED care for novel stroke, myocardial infarction (MI), hypoglycemia, or other T1D complications for those on GLP-1s, these findings were not statistically significant and might be due to random chance. It is important to note that the rates of new diabetic complications in one year for both groups were around 1%, indicating that these are uncommon outcomes regardless of medication use.

Figure 1. The likelihood of T1D patients experiencing diabetes complication by GLP-1 usage. Confidence intervals that cross the baseline likelihood indicate that the observed change in likelihood might be due to random chance. Patients with a history of the condition evaluated were excluded from analysis for that condition.

Delrue C, Speeckaert MM. Mechanistic pathways and clinical implications of GLP-1 receptor agonists in type 1 diabetes management. Int J Mol Sci. 2024;25(17):9351. doi:10.3390/ijms25179351
Li P, Li Z, Staton E, et al. GLP-1 Receptor Agonist and SGLT2 Inhibitor Prescribing in People With Type 1 Diabetes. JAMA Network. 2024;332(19):1667-1669. https://jamanetwork.com/journals/jama/article-abstract/2825312. Accessed February 4, 2025.
Cornell S. A review of GLP-1 receptor agonists in type 2 diabetes: A focus on the mechanism of action of once-weekly agents. J Clin Pharm Ther. 2020;45 Suppl 1(Suppl 1):17-27. doi:10.1111/jcpt.13230

Patients with Jaundice or a Pancreatic Mass or Cyst as an Initial Indication Receive the Quickest Pancreatic Cancer Diagnoses

Fri, 21 Mar 2025 11:00:00 +0000

Pancreatic cancer is one of the most aggressive malignancies, often diagnosed at advanced stages due to a lack of early symptoms.¹ Early detection remains a significant challenge, with diagnostic delays contributing to poor survival rates.² This study examines the time from the first recorded symptom, sign, or lab abnormality to a documented pancreatic cancer diagnosis and whether that time varies across populations.

We studied 50,980 patients diagnosed with pancreatic cancer between 2014 and 2024, excluding individuals with a cancer diagnosis of any type prior to their first documented symptom, sign, or abnormal lab. Time to diagnosis was calculated from the first recorded clinical finding known to be potentially associated with pancreatic cancer.

The median time to diagnosis across all patients was 116 days, as seen in Figure 1. When stratified by demographic factors, we found that patients aged 85+ experienced the longest time to diagnosis, with a median of 143 days, while those aged 65-74 had the shortest median time to diagnosis of 108 days. The median time to diagnosis was longer for Hispanic and Black patients at 149 days, while those who were non-Hispanic had a median of 115 days and non-Black patients had a median of 111 days. Female patients experienced longer time to diagnosis, with a median of 129 days, compared to male patients, whose median time was 104 days.

Figure 1. The median time to a pancreatic cancer diagnosis from the earliest recorded clinical finding by demographic factors.

We further studied median time to diagnosis based on the category of the earliest clinical finding that could be associated with a pancreatic cancer diagnosis. Patients were represented in multiple categories if more than one indication was documented on the same day. Patients who had pancreatobiliary symptoms, such as jaundice, a pancreatic mass, or a pancreatic cyst, had the shortest median time to diagnosis at 6 days. Those who had imaging were diagnosed within 14 days. On the other hand, patients with less specific indications like cardiovascular symptoms, such as blood clots, or new onset of diabetes had much longer median times to diagnosis, with several months between the initial indication and diagnosis of pancreatic cancer.

Figure 2. The median time to a pancreatic cancer diagnosis by first clinical finding type.

Can pancreatic cancer be found early? American Cancer Society. February 5, 2024. https://www.cancer.org/cancer/types/pancreatic-cancer/detection-diagnosis-staging/detection.html. Accessed February 5, 2025.
Khalaf N, Liu Y, Kramer JR, El-Serag HB, Kanwal F, Singh H. Defining and understanding diagnostic delays among pancreatic cancer patients: A retrospective cohort study. Clin Gastroenterol Hepatol. 2025;23(1):179-181.e3. doi:10.1016/j.cgh.2024.07.006

Patient Race and Location Influence Cesarean Rates for First-Time Deliveries

Tue, 18 Mar 2025 11:00:00 +0000

Cesarean delivery, also known as a C-section, is a surgical procedure in which a baby is delivered through an incision in the mother’s abdomen and uterus. While often necessary for maternal or fetal indications, it is associated with higher risks of maternal and neonatal complications, as well as increased healthcare costs, compared to vaginal delivery.¹^,2 Over the past decade, C-section rates have risen globally, raising concerns around potential overuse and its impact on maternal and neonatal health.^3,4 However, less is known about whether certain populations are more or less likely to have a C-section for their first delivery.

To better understand the demographics and clinical characteristics associated with cesarean deliveries, we studied 2,099,282 women who had their first delivery documented between January 1, 2017, and December 31, 2024. We excluded women who were younger than 14 years or older than 50 years at the time of birth or those whose baby had a gestational age less than 22 weeks or more than 45 weeks at delivery.

We found that the rate of first-time deliveries by cesarean was highest amongst Black mothers, with 33.8% of their deliveries occurring by C-section, while Hispanic mothers had the lowest rate of C-sections for their first delivery, as seen in Figure 1. C-sections are more common in the South and Northeast regions of the US. However, those living in rural areas had lower rates of C-sections than those in more densely populated areas.

Figure 1. The rate of cesarean deliveries for first-time births stratified by the mother’s demographic factors.

We found similar results in a sensitivity analysis adjusting for factors known to increase the risk of cesarean deliveries, such as conditions of the placenta or umbilical cord, position of the baby, or medical diagnoses the mother may have.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 295 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 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.

Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016 Feb 5;11(2):e0148343. doi: 10.1371/journal.pone.0148343. PMID: 26849801; PMCID: PMC4743929.
Negrini R, da Silva Ferreira RD, Guimarães DZ. Value-based care in obstetrics: comparison between vaginal birth and caesarean section. BMC Pregnancy Childbirth. 2021;21(1). doi:10.1186/s12884-021-03798-2
Caesarean section rates continue to rise, amid growing inequalities in access. World Health Organization. Published June 16, 2021. https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access. Accessed August 19, 2024.
Mallenbaum C, Beheraj K. 1 in 3 births: C-section rate increases, again. Axios. Published April 29, 2024. https://www.axios.com/2024/04/29/c-section-rate-high-why-risks. Accessed August 19, 2024.

RSV Vaccine Can Prevent More Than 70% of RSV Infections, ED Visits, and Admissions Among Older Adults

Kersten Bartelt, RN; Joe Deckert, PhD; Matthew Gracianette, MD; Eric Barkley — Thu, 06 Mar 2025 12:00:00 +0000

Respiratory syncytial virus (RSV) poses a significant health threat to older adults—particularly those with underlying conditions such as chronic lung disease, heart disease, or weakened immune function— increasing their risk of severe complications, hospitalization, and death.¹ The U.S. Food & Drug Administration (FDA) recently approved an RSV vaccine, offering a new preventive measure to reduce these risks.¹ The Centers for Disease Control and Prevention (CDC) currently recommends RSV vaccination for adults aged 60 to 74 with risk factors for severe RSV, as well as all adults aged 75 or older, to prevent infection and hospitalization.²

To evaluate the vaccine’s effectiveness, we studied 348,376 patients tested for RSV between May 2023 and December 2024. These patients were either 75 or older or aged 60 to 74 and at increased risk. We adjusted for patient age, geographic region, rural or urban status, social vulnerability, history of influenza vaccination, smoking history, and BMI. For patients 75 or older, we also adjusted for an increased risk of a severe RSV infection. All patients had an RSV lab result. We matched each patient with an RSV vaccine to four patients who did not get an RSV vaccine, were tested for RSV in the same month, and were the same age as the vaccinated patient.

We found that patients aged 60 to 74 who received the RSV vaccine were 73% less likely to have a medically attended RSV infection, 75% less likely to have an RSV-related ED visit, and 75% less likely to be admitted for RSV compared to those who did not receive the RSV vaccine. We also found similar rates of effectiveness in the 75 and older group, as shown in Figure 1.

Figure 1. The likelihood of a patient having a medically attended RSV infection, an RSV-related ED visit, or an RSV-related hospital admission by RSV vaccination status and patient age.

A sensitivity analysis of patients with RSV-like symptoms or an RSV diagnosis showed similar results.

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 December 26, 2024.
RSV vaccine guidance for older adults. U.S. Centers for Disease Control and Prevention. August 30, 2024. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/older-adults.html. Accessed December 26, 2024.

Telehealth Utilization Has Stabilized, Mental Health Departments Continue to See Highest Rates

Taylor Kirby — Tue, 04 Mar 2025 12:00:00 +0000

The use of telehealth to provide services to patients swiftly increased in early 2020 in response to COVID-19 pandemic policies. In the initial stages of the pandemic, we published several studies outlining how the use of telehealth had evolved.^1,2,3 As stay-at-home policies began to expire and healthcare organizations started re-opening clinics for non-emergent care, the use of telehealth declined, but remained elevated from pre-pandemic levels. However, medical specialties varied in their continued use of telehealth. In November 2023, we shared telehealth utilization over time by specialty and observed that mental health departments were continuing to see a greater proportion of their patients through telehealth than any other specialty.⁴

As healthcare organizations and policymakers consider ongoing investment and updating policies for care delivered through telehealth, we have launched a new data tracker to provide insight into trends in telehealth use over time and across a variety of specialties.

Figure 1. Monthly rates of telehealth encounters by medical specialty.

Similar to what we found in our previous brief, mental health departments continue to provide care through telehealth at nearly three times the rates of most other specialties, with almost one-third of visits delivered through telehealth. We will continue to update this tracker regularly, so be sure to check back for the latest.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 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.

Epic Research. Expansion of Telehealth During COVID-19 Pandemic. Epic Research. https://epicresearch.org/articles/expansion-of-telehealth-during-covid-19-pandemic. Accessed on February 26, 2025.
Fox B, Sizemore JO. As Office Visits Fall, Telehealth Takes Hold. Epic Research. https://epicresearch.org/articles/as-office-visits-fall-telehealth-takes-hold. Accessed on February 26, 2025.
Fox B, Sizemore JO. Telehealth: Fad or the Future. Epic Research. https://epicresearch.org/articles/telehealth-fad-or-the-future. Accessed on February 26, 2025.
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 February 26, 2025.

Women, Particularly Those Without Diabetes, More at Risk of Undiagnosed Chronic Kidney Disease

Thu, 27 Feb 2025 12:00:00 +0000

Chronic kidney disease (CKD) is a progressive condition characterized by declining kidney function. It is often undetected until later stages when dialysis or kidney failure becomes imminent.¹ An estimated 35.5 million U.S. adults have CKD, yet many remain undiagnosed, partly due to asymptomatic early stages and inconsistent screening practices.¹ Identifying CKD early can mitigate the risk of cardiovascular disease, acute kidney injury, and progression to kidney failure.²Despite these benefits, missed and discordant CKD diagnoses remain common.¹ CKD staging for stages 3a and greater are based on the patient’s estimated glomerular filtration rate (eGFR), with lower values indicating higher stages of CKD.³

We examined how often patients whose eGFR levels indicate they have stage 3 or higher CKD do not have a documented CKD diagnosis. We studied 681,583 patients with multiple creatinine labs at least 90 days apart whose calculated eGFR classified them as stage 3 or higher. Patients diagnosed with end-stage renal disease (ESRD) or those with a kidney transplant were excluded from this study, as transplant or dialysis procedures can interfere with eGFR values.

We found that, while most patients had a CKD diagnosis documented when their eGFR results reflect CKD, females were nearly twice as likely to be undiagnosed as males, as seen in Figure 1. The highest undiagnosed rate was among women without diabetes (20.0%).

Figure 1. The rate of having a CKD diagnosis among patients whose eGFR results indicate they have stage 3 CKD or higher.

Next, we evaluated how often the stage of the CKD diagnosis differed from the stage indicated by a patient’s eGFR results. We found that most patients have a diagnosed stage that matches their calculated stage, as seen in Figure 2. Patients classified as stage 5 were the least likely to have a staged diagnosis that matched their calculated stage. However, there were comparatively few patients with an eGFR indicating stage 5, and the exclusion of patients diagnosed with ESRD or who have had a transplant may disproportionately affect the rates observed among the stage 5 population.

Figure 2. The rate of patients with a staged CKD diagnosis that aligns with their eGFR level’s stage.

Chronic kidney disease in the United States, 2023. U.S. Centers for Disease Control and Prevention. May 15, 2024. https://www.cdc.gov/kidney-disease/php/data-research/index.html?. Accessed January 30, 2025.
Fraser SD, Blakeman T. Chronic kidney disease: identification and management in primary care. Pragmat Obs Res. 2016;7:21-32. Published 2016 Aug 17. doi:10.2147/POR.S97310
Testing for Chronic Kidney Disease. U.S. Centers for Disease Control and Prevention. May 15, 2024. https://www.cdc.gov/kidney-disease/testing/index.html. Accessed February 6, 2025.