Epic Research https://epicresearch.org/articles Facilitating rapid sharing of new medical knowledge Wed, 02 Jul 2025 12:53:57 +0000 en-US hourly 1 https://wordpress.org/?v=6.7.2 https://epicresearch.org/articles/wp-content/uploads/2020/04/cropped-EHRN-Favicon@2x-32x32.png Epic Research https://epicresearch.org/articles 32 32 Data Confirms Firstborns Take Their Time, Younger Siblings Born Sooner https://epicresearch.org/articles/data-confirms-firstborns-take-their-time-younger-siblings-born-sooner/ https://epicresearch.org/articles/data-confirms-firstborns-take-their-time-younger-siblings-born-sooner/#respond Wed, 02 Jul 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5735 Obstetricians and expectant parents often note that first-time births are more likely to be delayed, attributing this to the body’s initial physiological adjustment to labor. While some literature suggests first births may be more prone to late deliveries,1 other studies have found first births to be more prone to a preterm delivery.2 This study aims to quantify how birth order affects the likelihood of a “late” delivery, helping expectant mothers and their clinicians better understand what is typical for first births compared to subsequent ones.

To understand the relationship between birth order and “late” delivery, we studied more than 2 million pregnancies resulting in a live, full-term, single birth between 37- and 43-weeks’ gestation, excluding inductions or cesarean deliveries. We compared gestational duration and rate of delivery beyond 41 weeks between those who have had a prior delivery and those who have not.

When evaluating the rate of deliveries taking place past 41 weeks’ gestation, we found that 6.2% of first-time deliveries among mothers with no prior pregnancy extended beyond this point. This was 1.53 times more often than for those with a prior delivery, where only 4.0% delivered after 41 weeks. Among mothers with a prior pregnancy loss before 20 weeks, 5.8% of first full-term births occurred after 41 weeks.

Rate of Deliveries Beyond 41 Weeks Gestation
Figure 1. The rate of deliveries occurring after 41 weeks’ gestation by prior pregnancy and delivery status.

When looking at the distribution of gestational age at delivery, we found that patients who have not had a prior delivery have an average gestation of 275.9 days compared to 274.5 days among mothers who have delivered before, a statistically significant difference, as seen in Figure 1.

Gestational Age Distribution by Prior Delivery Status
Figure 2. The distribution of gestational ages at delivery by prior delivery status.

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 1,700 hospitals and more than 40,000 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.

  1. Caughey AB, Stotland NE, Washington AE, Escobar GJ. Who is at risk for prolonged and postterm pregnancy?. Am J Obstet Gynecol. 2009;200(6):683.e1-683.e6835. doi:10.1016/j.ajog.2009.02.034
  2. Astolfi P, Zonta LA. Risks of preterm delivery and association with maternal age, birth order, and fetal gender. Hum Reprod. 1999;14(11):2891-2894. doi:10.1093/humrep/14.11.2891

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Patient Portal Use Associated with 21 Million Fewer Visit No-Shows in 2024 https://epicresearch.org/articles/patient-portal-use-associated-with-21-million-fewer-visit-no-shows-in-2024/ https://epicresearch.org/articles/patient-portal-use-associated-with-21-million-fewer-visit-no-shows-in-2024/#respond Tue, 01 Jul 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5728 Missed outpatient appointments, or no-shows, disrupt care continuity, reduce clinic efficiency, and impact availability for other patients. Digital tools, such as patient portals, might improve appointment adherence by enhancing communication and engagement.1 MyChart, Epic’s patient portal, allows patients to schedule and manage appointments, receive reminders, and access care-related information and is the patient portal assessed for this study. 

We studied more than 1.6 billion face-to-face outpatient visits in 2024, comparing no-show rates for patients with and without an established patient portal account at the time the appointment was scheduled.  

Overall, patients with an active patient portal had a no-show rate of 6.2%, compared to 7.9% for those without, as seen in Figure 1. Patients aged 50–64 saw the greatest percentage point difference (6.2% vs. 8.7%) followed by those aged 35–49 (7.8% vs. 9.9%). Younger patients had smaller gaps, with the smallest difference seen among 18–34-year-olds (9.3% vs. 10.9%). 

No-Show Rates by Patient Age and Portal Usage
Figure 1. The rate of no-show appointments in 2024 by patient age and portal usage. 

Converting this finding to a rate, approximately 1,700 fewer no-shows occurred for patients with portal accounts per every 100,000 scheduled visits. This equates to more than 21 million fewer no-shows in one year across the 1.26 billion scheduled visits among patient-portal users in 2024. 

A sensitivity analysis accounting for other factors such as patient demographics, social vulnerability, appointment lead time, rate of no-shows in 2023, social drivers of health, insurance type, and number of recent visits showed similar patterns. 


These data come from summarized metrics of organizations that use the Epic EHR to provide direct patient care. 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.   

  1. Carini E, Villani L, Pezzullo AM, et al. The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review. J Med Internet Res. 2021;23(9):e26189. Published 2021 Sep 8. doi:10.2196/26189
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Some Bone Density Treatments Linked to Increased Likelihood of Heart Attack and Atrial Fibrillation https://epicresearch.org/articles/some-bone-density-treatments-linked-to-increased-likelihood-of-heart-attack-and-atrial-fibrillation/ https://epicresearch.org/articles/some-bone-density-treatments-linked-to-increased-likelihood-of-heart-attack-and-atrial-fibrillation/#respond Thu, 26 Jun 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5722 Osteoporosis medications are used to treat loss of bone density and prevent fractures. Despite their benefits, some studies have raised potential concerns about the use of these treatments increasing the risk of cardiovascular conditions.1,2 Standard first-line therapies for bone density disorders include denosumab and bisphosphonates. In severe cases, or if initial treatment is unsuccessful, doctors may prescribe alternative therapies such as romosozumab, teriparatide, or abaloparatide.3 

To explore the relationship between osteoporosis medications and cardiovascular events, we studied 447,208 patients with osteoporosis or osteopenia. We factored in patient age, sex, BMI, smoking status, and histories of hyperlipidemia, diabetes, chronic kidney disease, and cardiovascular disease. Patients prescribed more than one of the studied medications within the follow-up period were excluded. 

We found that patients prescribed bisphosphonates were slightly less likely to experience an ischemic stroke compared to patients prescribed calcium or vitamin D. Patients prescribed denosumab were 23% more likely to be diagnosed with AFib, while patients prescribed teriparatide were 44% more likely to be diagnosed with AFib and 35% more likely to experience an MI than patients prescribed calcium or vitamin D. Patients prescribed romosozumab or abaloparatide were not conclusively more or less likely to experience the conditions studied compared to those prescribed calcium or vitamin D. 

Likelihood of Cardiovascular Condition Within Three Years by Osteoporosis Medication
Figure 1. The likelihood of experiencing an ischemic stroke, myocardial infarction, or atrial fibrillation within three years of starting treatment by osteoporosis medication. 

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. 

  1. Azeez TA. Osteoporosis and cardiovascular disease: a review. Mol Biol Rep. 2023;50(2):1753-1763. doi:10.1007/s11033-022-08088-4 
  2. Lv F, Cai X, Yang W, et al. Denosumab or romosozumab therapy and risk of cardiovascular events in patients with primary osteoporosis: Systematic review and meta- analysis. Bone. 2020;130(115121):115121. doi:10.1016/j.bone.2019.115121 
  3. Osteoporosis treatment: Medications can help. Mayo Clinic. Published August 28, 2024. https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis-treatment/art-20046869. Accessed September 13, 2024. 
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Early Childhood Antibiotic Use Not Associated with Increased Celiac Disease Risk https://epicresearch.org/articles/early-childhood-antibiotic-use-not-associated-with-increased-celiac-disease-risk/ https://epicresearch.org/articles/early-childhood-antibiotic-use-not-associated-with-increased-celiac-disease-risk/#respond Tue, 24 Jun 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5718 Celiac disease is a chronic autoimmune condition triggered by gluten ingestion.1 Prior studies have speculated that early antibiotic use may disrupt the gut microbiome, potentially increasing susceptibility to autoimmune disorders, including celiac disease.2,3 We aimed to understand the relationship between antibiotics given in early childhood and subsequent diagnoses of celiac disease. 

We studied 597,531 children from birth through age 6 and categorized them based on the number of antibiotic courses the child received in the first year of life. We limited our analysis to antibiotics in the first year of life to avoid potential conflation with antibiotics often prescribed in later childhood as part of an assessment for celiac disease. We included patient demographics, gestational age and delivery method, frequency of outpatient care, number of first year infections, and maternal history of celiac disease in our analysis. 

Overall, while antibiotic use was associated with a lower likelihood of being diagnosed with celiac disease by age 6, this result was only significant for those who had 3-5 prescriptions, as seen in Figure 1.  

Celiac Disease Likelihood by Antibiotic Course Count
Figure 1. The likelihood of a child being diagnosed with celiac disease by age 6 by the number of antibiotic courses they had during the first year of life. 

We found similar results when assessing antibiotic use before age 3, celiac disease by age 3, and in patients without a history of surgery.  


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 1,700 hospitals and more than 40,000 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. 

  1. Definition & facts for celiac disease. National Institute of Diabetes and Digestive and Kidney Diseases. April 15, 2025. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts. Accessed April 22, 2025. 
  2. Kołodziej M, Patro-Gołąb B, Gieruszczak-Białek D, et al. Association between early life (prenatal and postnatal) antibiotic administration and coeliac disease: a systematic review. Arch Dis Child. 2019;104(11):1083-1089. doi:10.1136/archdischild-2019-317174 
  3. Kamphorst K, Van Daele E, Vlieger AM, Daams JG, Knol J, van Elburg RM. Early life antibiotics and childhood gastrointestinal disorders: a systematic review. BMJ Paediatr Open. 2021;5(1):e001028. Published 2021 Mar 3. doi:10.1136/bmjpo-2021-001028 
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Preference for Salpingectomies over Tubal Ligations Among Female Sterilization Procedures Is Increasing https://epicresearch.org/articles/preference-for-salpingectomies-over-tubal-ligations-among-female-sterilization-procedures-is-increasing/ https://epicresearch.org/articles/preference-for-salpingectomies-over-tubal-ligations-among-female-sterilization-procedures-is-increasing/#respond Mon, 16 Jun 2025 09:00:00 +0000 https://epicresearch.org/articles/?p=5711 Female sterilization procedures, including tubal ligations and salpingectomies (surgical removal of the fallopian tubes), have long been a primary method of permanent contraception. In recent years, medical evidence has highlighted the benefits of salpingectomy over tubal ligation, including potential reduction in ovarian cancer risk, leading to a reevaluation of clinical practices and patient preferences.1 

We studied 509,895 patients who had a sterilization procedure performed between 2015 and 2024 to better understand the evolving dynamics of tubal ligations and salpingectomies. We found that the salpingectomy-to-tubal ligation ratio rose from 1.2 in 2015 to 3.3 in 2024. Notably, the accelerated trend after 2019 coincides with the publication from The American College of Obstetricians and Gynecologists that demonstrated the protective benefits of salpingectomy against ovarian cancer. 

Salpingectomy to Tubal Ligation Ratio
Figure 1. The ratio of salpingectomies to tubal ligations performed. A ratio of 1 indicates that both procedures were performed with the same frequency. A ratio greater than 1 indicates that salpingectomies were performed more frequently than tubal ligations. For example, a ratio of 3.3 indicates that there were 33 salpingectomies performed for every 10 tubal ligations.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 294 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. 

  1. Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. The American College of Obstetricians and Gynecologists. 4/2019. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/opportunistic-salpingectomy-as-a-strategy-for-epithelial-ovarian-cancer-prevention. Accessed January 27, 2025. 
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Early Surgery Not Associated With Reduced Rate of Sleep Apnea or Speech Disorders in Patients With Tongue-Tie https://epicresearch.org/articles/early-surgery-not-associated-with-reduced-rate-of-sleep-apnea-or-speech-disorders-in-patients-with-tongue-tie/ https://epicresearch.org/articles/early-surgery-not-associated-with-reduced-rate-of-sleep-apnea-or-speech-disorders-in-patients-with-tongue-tie/#respond Thu, 12 Jun 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5699 Lingual frenotomy, a surgery to release connected tissue beneath the tongue, is frequently performed in newborns diagnosed with tongue-tie or feeding difficulties. Although proponents suggest that early lingual frenotomy may mitigate future risks of speech disorders or sleep-disordered breathing, recommendations around the procedure remain limited.1,2 We aimed to understand trends in frenotomy procedures and whether frenotomy performed within six weeks of birth influences the risk of sleep apnea or speech disorders by age 5. 

In the first quarter of 2015, lingual frenotomy occurred in 98 per 10,000 babies. The rate rose to a peak of 212 per 10,000 babies in the second quarter of 2021, as seen in Figure 1. The rate then trended down slightly, to 158 per 10,000 babies in the last quarter of 2024. 

Lingual Frenotomy Rate by Quarter
Figure 1. The quarterly rate of newborns who have a lingual frenotomy within six weeks of birth. 

Next, we looked at the association between lingual frenotomies and the outcomes of sleep disorders and speech disorders among children who were diagnosed with tongue-tie. We compared patients who did not have surgery to those that did have surgery and included patient sex, social vulnerability, rural-urban classification, and prematurity status in our analysis.  

We found that rates of obstructive sleep apnea and speech disorders were not significantly different between the populations, as seen in Figure 2. Children who had a prior frenotomy had slightly higher rates of central sleep apnea (422 per 10,000 babies vs. 307 per 10,000 babies) by their fifth birthday. Limiting the analysis to patients with a diagnosed feeding difficulty showed similar results. 

Sleep Apnea and Speech Disorder Rates with and Without Frenotomy
Figure 2. The rates of sleep apnea and speech disorders among children diagnosed with tongue-tie at birth by whether they had a lingual frenotomy within six weeks of birth. 

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 1,700 hospitals and more than 40,000 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. 

  1. Carnino JM, Rodriguez Lara F, Chan WP, Kennedy DG, Levi JR. Speech Outcomes of Frenectomy for Tongue-Tie Release: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol. 2024;133(6):566-574. doi:10.1177/00034894241236234 
  2. Messner AH, Walsh J, Rosenfeld RM, et al. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020;162(5):597-611. doi:10.1177/0194599820915457 
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Prediabetes Among Teens up More Than 75% Since 2018 https://epicresearch.org/articles/prediabetes-among-teens-up-more-than-75-since-2018/ https://epicresearch.org/articles/prediabetes-among-teens-up-more-than-75-since-2018/#respond Tue, 10 Jun 2025 15:30:00 +0000 https://epicresearch.org/articles/?p=5691 Prediabetes is a condition associated with increased blood sugar levels that increases a patient’s risk for future type 2 diabetes and other chronic illnesses.1 While the United States Preventive Services Task Force (USPSTF) screening guidelines recommend beginning prediabetes screening at age 35,2 earlier screening is recommended by the American Diabetes Association when there is increased risk such as obesity or family history.3  

We aimed to understand trends in HbA1c testing and prediabetes among teenage patients. We studied 18,182,111 teens aged 13–18 who had at least one healthcare visit between Q1 2018 and Q1 2025, with 1,000,628 receiving an HbA1c test. 

We found that HbA1c testing rates have increased since 2018. In the first quarter of 2018, 1.4% of male teens had their HbA1c tested, compared to 2.2% in the first quarter of 2025, as seen in Figure 1. Similarly, the HbA1c testing rate for female teens rose from 1.4% to 2.5% over the same period. Rising testing rates may indicate that there are more teens considered at increased risk of developing diabetes. It may also indicate better screening of teens who are at increased risk. 

Percentage of Teens with an HbA1c Test
Figure 1. The percentage of teens with an HbA1c tests by quarter from 2018 to the first quarter of 2025. 

Over the study period, the proportion of HbA1c tests for male teens that met prediabetic HbA1c thresholds (5.7–6.4%) rose from 14% in the first quarter of 2018 to 16% in the first quarter of 2025. HbA1c tests for female teens, on the other hand, had steady positivity rates of around 12% in the same period. 

Percentage of HbA1C Tests Among Teens Reaching a Prediabetic HbA1c Level
Figure 2. The percentage of HbA1c results for teens that reached a prediabetes threshold (5.7-6.4%) among those without existing prediabetes or diabetes. 

Because testing rates have increased, the absolute incidence of newly identified prediabetic-level HbA1c results has also risen, as shown in Figure 3. Among male teens, 19 per 10,000 had a prediabetic HbA1c in the first quarter of 2018, compared to 35 per 10,000 in the first quarter of 2025—an 84% increase. For female teens, the incidence rose from 16 to 28 per 10,000 over the same period, marking a 75% increase.  

Portion of Teens Newly Reaching a Prediabetic HbA1c Level
Figure 3. The portion of teens with HbA1c results reaching prediabetes thresholds (5.7-6.4%) among those without existing prediabetes or diabetes. 

Previous research shows that obesity is a strong modifiable risk factor for insulin resistance in youth, so we stratified teens with a prediabetic HbA1c by their BMI classifcation.4 We found that more than half had a BMI classifying them as obese, while an additional roughly 10% were classified as overweight. These proportions were consistent across patient sex and time.  

BMI Classification Among Teens with Prediabetic HbA1c Level
Figure 4. The BMI classification among teens with a prediabetic HbA1c level. 

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 1,700 hospitals and more than 40,000 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. 

  1. Prediabetes – your chance to prevent type 2. U.S. Centers for Disease Control and Prevention. May 15, 2024. https://www.cdc.gov/diabetes/prevention-type-2/prediabetes-prevent-type-2.html?CDC_AAref_Val=https://www.cdc.gov/diabetes/basics/prediabetes.html. Accessed May 12, 2025. 
  2. Prediabetes and type 2 diabetes: Screening. (2021, August 24). U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes. Accessed May 12, 2025. 
  3. American Diabetes Association. (2018). 2. Classification and diagnosis of diabetes: Standards of Medical Care in diabetes-2018. Diabetes Care, 41(Suppl 1), S13–S27. https://doi.org/10.2337/dc18-S002 
  4. Ouyang, A., Hu, K., & Chen, L. (2024). Trends and risk factors of diabetes and prediabetes in US adolescents, 1999-2020. Diabetes Research and Clinical Practice, 207(111022), 111022. https://doi.org/10.1016/j.diabres.2023.111022 
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Women on Antihypertensive Treatment Achieve Higher Rates of Blood Pressure Control Early in Treatment Than Men https://epicresearch.org/articles/women-on-antihypertensive-treatment-achieve-higher-rates-of-blood-pressure-control-early-in-treatment-than-men/ https://epicresearch.org/articles/women-on-antihypertensive-treatment-achieve-higher-rates-of-blood-pressure-control-early-in-treatment-than-men/#respond Wed, 04 Jun 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5682 Hypertension, or high blood pressure, remains a leading modifiable risk factor for cardiovascular disease and stroke.1 Previous research has shown that women and men have differences in baseline blood pressure and adverse outcome risk.2,3  

To understand the differences in overall effectiveness of antihypertensive treatment by sex, we studied non-pregnant adult patients who started treatment for hypertension and had a baseline systolic blood pressure (SBP) greater than 130 mmHg, which is considered hypertensive.4 We factored patient demographics, baseline blood pressure, comorbidities, prior medication use, and smoking status into our analysis. 

One month into treatment, women were 10.7% more likely to achieve blood pressure control (SBP under 130 mmHg) compared to men, as seen in Figure 1. This difference persisted at three months, albeit slightly reduced, with women 9.5% more likely to achieve an SBP under 130mmHg than men.  

Women’s Likelihood of Achieving Blood Pressure Control Compared to Men
Figure 1. The likelihood of a patient reaching an SBP under 130 mmHg one and three months after starting treatment by sex. 

Next, we evaluated long-term outcomes, including stroke and atherosclerotic cardiovascular disease (ASCVD) events. ASCVD events include myocardial infarction (MI), peripheral arterial disease, and acute coronary syndrome. We found that women were 4.3% less likely to have a stroke and 23.8% less likely to have an ASCVD event within three years of starting the treatment, as seen in Figure 2. 

Women’s Likelihood of Stroke or ASCVD Event Within Three Years Compared to Men
Figure 2. The likelihood of a patient having a stroke or ASCVD event within three years after starting treatment by sex. 

Individual medication dosages and patient adherence to their prescribed medication were not studied as part of this analysis. Additionally, even though baseline SBP differs by sex, we found similar results after adjusting for baseline SBP. 


These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 299 million patient records from 1,700 hospitals and more than 40,000 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. 

  1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018 Jun;71(6):e140-e144. doi: 10.1161/HYP.0000000000000076.]. Hypertension. 2018;71(6):e13-e115. doi:10.1161/HYP.0000000000000065 
  2. Reckelhoff JF. Gender differences in the regulation of blood pressure. Hypertension. 2001;37(5):1199-1208. doi:10.1161/01.hyp.37.5.1199 
  3. Sandberg K, Ji H. Sex differences in primary hypertension. Biol Sex Differ. 2012;3(1):7. Published 2012 Mar 14. doi:10.1186/2042-6410-3-7 
  4. LeWine, H. E. (2024, March 26). Reading the new blood pressure guidelines. Harvard Health. https://www.health.harvard.edu/heart-health/reading-the-new-blood-pressure-guidelines. Accessed May 14, 2025. 
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Patient Portal Users Are More Likely to be Up to Date with Breast Cancer Screenings https://epicresearch.org/articles/patient-portal-users-are-more-likely-to-be-up-to-date-with-breast-cancer-screenings/ https://epicresearch.org/articles/patient-portal-users-are-more-likely-to-be-up-to-date-with-breast-cancer-screenings/#respond Tue, 13 May 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5675 The U.S. Preventative Services Task Force (USPSTF) recommends breast cancer screening every other year for women aged 40 to 74 with average risk of breast cancer. Screening makes early detection possible and can significantly improve treatment outcomes.1 Additionally, patient engagement through electronic health portals has been associated with improved preventive care adherence.2 We aimed to understand whether active use of a patient portal, such as Epic’s MyChart, is correlated with a higher rate of being up to date on breast cancer screenings.

We studied 11,764,325 women aged 40 to 74 with no prior history of breast cancer who had a medical visit in 2024 and another at least two years prior. To assess breast cancer screening history, we reviewed care provided within the three years prior to their visit in 2024.

We found that patient portal users consistently had higher rates of screening in alignment with USPSTF screening recommendations in each age group studied, as seen in Figure 1.

Rate Up-to-Date Breast Cancer Screenings by Patient Portal Usage and Age
Figure 1. The rate of women having an up-to-date breast cancer screening by patient portal usage and age.

White patients had the largest gap between portal users and non-users, and White non-portal users were screened at the lowest rate compared to patients of other races and ethnicities at 53.9%, as seen in Figure 2. Breast cancer screening rates were the highest among Black portal users at 81.4%, while Black non-users were screened 66.2% of the time.

Rate of Up-to-Date Breast Cancer Screenings by Patient Portal Usage, Race, and Ethnicity
Figure 2. The rate of women having an up-to-date breast cancer screening by patient portal usage, race, and ethnicity.

Women classified as high risk had higher screening rates than all other studied groups, with portal users still having higher rates than non-users (89.0% for users vs. 81.3% for non-users), as seen in Figure 3. Among women not classified as high risk, portal users still had higher screening adherence (74.8% for users vs. 57.0% for non-users). However, high-risk non-users had higher screening rates than not-high-risk portal users.

Rate of Up-to-Date Breast Cancer Screenings by Patient Portal Usage and Risk
Figure 3. The rate of women having an up-to-date breast cancer screening by patient portal usage and whether they are considered high risk for having breast cancer.

Of note, screenings that occur outside of a Cosmos-participating organization are not always documented, which might contribute to an undercounting of screenings in this analysis.


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 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.

  1. Breast cancer: Screening. U.S. Preventative Services Task Force. April 30, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening. Accessed February 18, 2025.
  2. Huang J, Chen Y, Landis JR, Mahoney KB. Difference Between Users and Nonusers of a Patient Portal in Health Behaviors and Outcomes: Retrospective Cohort Study. J Med Internet Res. 2019;21(10):e13146. Published 2019 Oct 7. doi:10.2196/13146
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Surgical Site Infection Rates for Colorectal Surgery Have Increased 21% Since 2019 https://epicresearch.org/articles/surgical-site-infection-rates-for-colorectal-surgery-have-increased-21-since-2019/ https://epicresearch.org/articles/surgical-site-infection-rates-for-colorectal-surgery-have-increased-21-since-2019/#respond Thu, 08 May 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5668 Surgical site infections (SSIs) are a type of healthcare-associated infection and are associated with poorer health outcomes, extended hospital stays, and higher healthcare costs.1 While there are a number of factors that can contribute to the likelihood of developing an SSI, identifying procedures that are most likely to result in an infection can help to tailor prevention and treatment efforts.  

To better understand trends in SSIs, we studied 5,357,545 surgeries performed between January 1, 2019, and September 30, 2024, by procedure type, including colorectal surgery, cesarean section (C-section), hip replacement, knee replacement, and abdominal hysterectomy. These procedures represent the most common types of procedures with data reported to the National Healthcare Safety Net (NHSN).2 

Colorectal surgeries consistently demonstrated the highest rate of SSI across the study period, as seen in Figure 1. Following a temporary decline in early 2020—possibly due to pandemic-related reductions in elective surgery volumes and enhanced infection control3—colorectal surgery infection rates returned to previous rates and then rose steadily, reaching 7.4% in Q3 2024 from 6.1% in Q4 2019.  

C-sections saw a slight rise in SSI rates from 1.0% in Q2 2020 to 1.3% in Q3 2024, maintaining relatively low infection rates overall. Hysterectomy-related SSIs fluctuated more, while still having relatively low infection rates. Knee replacement infection rates remained 0.8% or less in all quarters, while hip replacement SSIs were 1.5% or less.  

Surgical Site Infection Rates by Procedure Type
Figure 1. The rate of surgical site infections by procedure type over time. 

Of note, infection preventionists manually link infections to procedures to identify them as SSIs, which could introduce variability in case identification. 


These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 299 million patient records from 1,700 hospitals and more than 40,000 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. 

  1. Surgical site infection. World Health Organization. https://www.who.int/teams/integrated-health-services/infection-prevention-control/surgical-site-infection. Accessed April 15, 2025. 
  2. Surgical Site Infection Event (SSI). U.S. Centers for Disease Control and Prevention. 1/2025.  https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed April 24, 2025. 
  3. Mehta A, Awuah WA, Ng JC, et al. Elective surgeries during and after the COVID-19 pandemic: Case burden and physician shortage concerns. Ann Med Surg (Lond). 2022;81:104395. doi:10.1016/j.amsu.2022.104395 
  4. Surgical Site Infection (SSI) Events. (2025, January 1). U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/nhsn/psc/ssi/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fnhsn%2Facute-care-hospital%2Fssi%2Findex.html
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