Epic Research https://epicresearch.org/articles Facilitating rapid sharing of new medical knowledge Wed, 26 Mar 2025 19:53:06 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.5 https://epicresearch.org/articles/wp-content/uploads/2020/04/cropped-EHRN-Favicon@2x-32x32.png Epic Research https://epicresearch.org/articles 32 32 Hurricanes Have Minimal Influence on Sinus Infection Rates https://epicresearch.org/articles/hurricanes-have-minimal-influence-on-sinus-infection-rates/ https://epicresearch.org/articles/hurricanes-have-minimal-influence-on-sinus-infection-rates/#respond Thu, 27 Mar 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5623 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.1,2 Previous 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).58 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. 

Annual Comparisons of Acute Sinus Infections Post Hurricane by Hurricane Path
Figure 1. Five-week rolling average of seasonal acute sinus infection rates in the geographic areas affected by hurricanes Ian, Nicole, Idalia, and Debby. 
Annual Comparisons of Chronic Sinus Infections Post Hurricane by Hurricane Path
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. 

  1. 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 
  2. 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/ 
  3. 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 
  4. 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 
  5. 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 
  6. 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 
  7. 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 
  8. 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
]]>
https://epicresearch.org/articles/hurricanes-have-minimal-influence-on-sinus-infection-rates/feed/ 0
Some Diabetic Complications Less Likely Among Type 1 Diabetics on GLP-1s https://epicresearch.org/articles/some-diabetic-complications-less-likely-among-type-1-diabetics-on-glp-1s/ https://epicresearch.org/articles/some-diabetic-complications-less-likely-among-type-1-diabetics-on-glp-1s/#respond Tue, 25 Mar 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5618 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. 

Likelihood of New Diabetes Complications by GLP-1 Usage
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.

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. 

  1. 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 
  2. 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. 
  3. 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 
]]>
https://epicresearch.org/articles/some-diabetic-complications-less-likely-among-type-1-diabetics-on-glp-1s/feed/ 0
Patients with Jaundice or a Pancreatic Mass or Cyst as an Initial Indication Receive the Quickest Pancreatic Cancer Diagnoses https://epicresearch.org/articles/patients-with-jaundice-or-a-pancreatic-mass-or-cyst-as-an-initial-indication-receive-the-quickest-pancreatic-cancer-diagnoses/ https://epicresearch.org/articles/patients-with-jaundice-or-a-pancreatic-mass-or-cyst-as-an-initial-indication-receive-the-quickest-pancreatic-cancer-diagnoses/#respond Fri, 21 Mar 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5609 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.  

Median Time to Pancreatic Cancer Diagnosis by Demographic Factors
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. 

Median Time to Pancreatic Cancer Diagnosis by Earliest Clinical Finding
Figure 2. The median time to a pancreatic cancer diagnosis by first clinical finding type.

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. 

  1. 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. 
  2. 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 
]]>
https://epicresearch.org/articles/patients-with-jaundice-or-a-pancreatic-mass-or-cyst-as-an-initial-indication-receive-the-quickest-pancreatic-cancer-diagnoses/feed/ 0
Patient Race and Location Influence Cesarean Rates for First-Time Deliveries https://epicresearch.org/articles/patient-race-and-location-influence-cesarean-rates-for-first-time-deliveries/ https://epicresearch.org/articles/patient-race-and-location-influence-cesarean-rates-for-first-time-deliveries/#respond Tue, 18 Mar 2025 11:00:00 +0000 https://epicresearch.org/articles/?p=5599 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.  

Rate of Cesarean Deliveries Among First-Time Deliveries by Demographic Factors
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. 

  1. 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. 
  2. 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 
  3. 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. 
  4. 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. 
]]>
https://epicresearch.org/articles/patient-race-and-location-influence-cesarean-rates-for-first-time-deliveries/feed/ 0
RSV Vaccine Can Prevent More Than 70% of RSV Infections, ED Visits, and Admissions Among Older Adults https://epicresearch.org/articles/rsv-vaccine-can-prevent-more-than-70-of-rsv-infections-ed-visits-and-admissions-among-older-adults/ https://epicresearch.org/articles/rsv-vaccine-can-prevent-more-than-70-of-rsv-infections-ed-visits-and-admissions-among-older-adults/#respond Thu, 06 Mar 2025 12:00:00 +0000 https://epicresearch.org/articles/?p=5584 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. 

RSV Vaccine Effectiveness by Patient Age
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. 


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. 

  1. 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. 
  2. 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. 
]]>
https://epicresearch.org/articles/rsv-vaccine-can-prevent-more-than-70-of-rsv-infections-ed-visits-and-admissions-among-older-adults/feed/ 0
Telehealth Utilization Has Stabilized, Mental Health Departments Continue to See Highest Rates https://epicresearch.org/articles/telehealth-utilization-has-stabilized-mental-health-departments-continue-to-see-highest-rates/ https://epicresearch.org/articles/telehealth-utilization-has-stabilized-mental-health-departments-continue-to-see-highest-rates/#respond Tue, 04 Mar 2025 12:00:00 +0000 https://epicresearch.org/articles/?p=5577 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.  

Telehealth Utilization Data Tracker
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.  

  1. 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.  
  2. 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. 
  3. 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. 
  4. 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.  
]]>
https://epicresearch.org/articles/telehealth-utilization-has-stabilized-mental-health-departments-continue-to-see-highest-rates/feed/ 0
Women, Particularly Those Without Diabetes, More at Risk of Undiagnosed Chronic Kidney Disease https://epicresearch.org/articles/women-particularly-those-without-diabetes-more-at-risk-of-undiagnosed-chronic-kidney-disease/ https://epicresearch.org/articles/women-particularly-those-without-diabetes-more-at-risk-of-undiagnosed-chronic-kidney-disease/#respond Thu, 27 Feb 2025 12:00:00 +0000 https://epicresearch.org/articles/?p=5567 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.2 Despite 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%). 

CKD Diagnosis Rate Among Patients Whose eGFR Indicates Stage 3 or Higher CKD
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. 

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

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. 

  1. 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. 
  2. 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 
  3. 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. 
]]>
https://epicresearch.org/articles/women-particularly-those-without-diabetes-more-at-risk-of-undiagnosed-chronic-kidney-disease/feed/ 0
Women Who Have Had an IUD No More Likely to Become Pregnant with Multiples https://epicresearch.org/articles/women-who-have-had-an-iud-no-more-likely-to-become-pregnant-with-multiples/ https://epicresearch.org/articles/women-who-have-had-an-iud-no-more-likely-to-become-pregnant-with-multiples/#respond Tue, 25 Feb 2025 12:00:00 +0000 https://epicresearch.org/articles/?p=5557 Some anecdotal reports suggest that women who have had an intrauterine device (IUD), a form of birth control placed in the uterus, have higher rates of multiple gestation pregnancies. While prior research has examined whether IUD use affects fertility,1,2 less is known about whether prior IUD use affects the rate of becoming pregnant with multiples. 

We studied 115,838 pregnancies in women with prior IUD use and 463,332 pregnancies in women without any documented history of birth control. We matched the two populations based on the mother’s age at conception, race, ethnicity, prior history of multiple births, height, and BMI. 

We found no meaningful difference in the rate of multiple gestation pregnancies between women with prior IUD use (1.79%) and those with no history of birth control use (1.84%), as seen in Figure 1. This finding held true for both hormonal and copper, or non-hormonal, IUDs. 

Multiple Gestation Pregnancy Rates by IUD Use
Figure 1. The rate of multiple gestation pregnancies by history of IUD use. 

A sensitivity analysis adjusting for the matching features in a logistic regression had similar results.


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. 

  1. Stoddard AM, Xu H, Madden T, Allsworth JE, Peipert JF. Fertility after intrauterine device removal: a pilot study. Eur J Contracept Reprod Health Care. 2015;20(3):223-230. doi:10.3109/13625187.2015.1010639 
  2. Gayatri M, Utomo B, Budiharsana M, Dasvarma G. Pregnancy resumption following contraceptive discontinuation: Hazard survival analysis of the Indonesia Demographic and Health Survey Data 2007, 2012 and 2017. PLoS One. 2022;17(2):e0264318. Published 2022 Feb 23. doi:10.1371/journal.pone.0264318 
]]>
https://epicresearch.org/articles/women-who-have-had-an-iud-no-more-likely-to-become-pregnant-with-multiples/feed/ 0
Appendicitis No More Likely After COVID-19 and Influenza Infections and Vaccinations Than Prior to Vaccination or Infection https://epicresearch.org/articles/appendicitis-no-more-likely-after-covid-19-and-influenza-infections-and-vaccinations-than-prior-to-vaccination-or-infection/ https://epicresearch.org/articles/appendicitis-no-more-likely-after-covid-19-and-influenza-infections-and-vaccinations-than-prior-to-vaccination-or-infection/#respond Tue, 11 Feb 2025 12:00:00 +0000 https://epicresearch.org/articles/?p=5548 Some reports have suggested an increased likelihood of appendicitis following viral infections, including COVID-19 and influenza infections, as well as following a COVID-19 vaccination.1,2,3 We aimed to understand the relationship between COVID-19 and influenza infections and vaccinations. 

We studied 2.7 million patients who had an influenza or COVID-19 vaccination or infection in 2022 or 2023. We adjusted for patient age, race, ethnicity, sex, smoking history, rural or urban status, history of infection or vaccination, and social vulnerability. We compared the likelihood of appendicitis or appendectomy in the 30 days following the vaccine or infection exposure to the same 30-day window one year prior. 

We found no statistically significant change in the likelihood of being diagnosed with appendicitis or having an appendectomy for patients who had a COVID-19 infection, COVID-19 vaccination, influenza infection, or influenza vaccination compared to those without the exposure, as seen in Figure 1.  

Likelihood of Appendicitis or Appendectomy After an Infection or Vaccination
Figure 1. The likelihood of a patient experiencing appendicitis in the 30 days after a vaccination or infection compared to the likelihood a year prior.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 293 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. Georgakopoulou VE, Gkoufa A, Damaskos C, et al. COVID-19-associated acute appendicitis in adults. A report of five cases and a review of the literature. Exp Ther Med. 2022;24(1):482. Published 2022 Jun 1. doi:10.3892/etm.2022.11409 
  2. Soltani S, Kesheh MM, Siri G, et al. The role of viruses in human acute appendicitis: a systematic literature review. Int J Colorectal Dis. 2023;38(1). doi:10.1007/s00384-023-04391-z 
  3. Oganesyan A, Schäfer M, Lesh C. Acute appendicitis following the COVID-19 vaccine. J Surg Case Rep. 2022;2022(6):rjac295. doi:10.1093/jscr/rjac295 
]]>
https://epicresearch.org/articles/appendicitis-no-more-likely-after-covid-19-and-influenza-infections-and-vaccinations-than-prior-to-vaccination-or-infection/feed/ 0
After a Decade of Increase, Obesity and Severe Obesity Have Trended Back Down https://epicresearch.org/articles/after-a-decade-of-increase-obesity-and-severe-obesity-have-trended-back-down/ https://epicresearch.org/articles/after-a-decade-of-increase-obesity-and-severe-obesity-have-trended-back-down/#respond Tue, 04 Feb 2025 12:00:00 +0000 https://epicresearch.org/articles/?p=5540 Recently, there have been conflicting reports on the trends in obesity rates in the U.S., with some reporting a peak in the rate of obesity and others reporting the rate of obesity will continue to climb through at least 2025.1,2,3 The U.S. Centers for Disease Control and Prevention (CDC) reports that obesity increases the risk of high blood pressure, diabetes, and heart disease among patients as well as increased medical expenditure.4  

We aimed to understand the trends in adult BMIs since 2010. We studied the BMI classification of more than 109 million patients who had an outpatient visit between Q1 2010 and Q3 2024.  

We found that the percentage of adults classified as obese (BMI of 30 or greater) increased from around 40% in 2010 to around 45% in 2020, a 13.6% increase, and this rate remained fairly stable through 2024. The rate of severe obesity (BMI of 40 or greater) increased from 8.5% of patients in 2010 to 10.7% in 2021, followed by a downward trend to 10.3% in 2024.The rate of patients with a healthy weight dropped from 27.7% to 23.2% between 2010 and 2024. 

BMI Classification Trends Over Time
Figure 1. Annual BMI classification rates and the annual BMI classification difference compared to 2010 among U.S. adults.

Next, we examined the median BMI by age group. We found that adults aged 18 to 39 experienced the most significant increase, with median BMI rising from 26.1 in 2010 to 27.2 in 2024, a 4.4% increase. For adults aged 40 to 59, the median BMI increased from 28.6 in 2010 to 29.3 in 2024, a 2.6% increase. In contrast, adults aged 60 to 75 showed little change between 2010 and 2020, and then the median decreased through 2024. 

Median BMI by Age Over Time
Figure 2. The annual median BMI by age group.

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. Ng M, Dai X, Cogen RM, et al. National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990–2021, and forecasts up to 2050. Lancet. Published online 2024. doi:10.1016/s0140-6736(24)01548-4 
  2. Emmerich S, Fryar C, Stierman B, Ogden C. Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023. National Center for Health Statistics (U.S.); 2024. 
  3. Burn-Murdoch J. We may have passed peak obesity. Financial Times. https://www.ft.com/content/21bd0b9c-a3c4-4c7c-bc6e-7bb6c3556a56. October 4, 2024. Accessed November 21, 2024. 
  4. Adult obesity facts. U.S. Centers for Disease Control and Prevention. May 14, 2024. https://www.cdc.gov/obesity/adult-obesity-facts/. Accessed November 21, 2024. 
]]>
https://epicresearch.org/articles/after-a-decade-of-increase-obesity-and-severe-obesity-have-trended-back-down/feed/ 0