To understand the prescribing patterns of suzetrigine, we studied 21,386 adult patients prescribed suzetrigine and compared them to 986,460 patients prescribed an opioid between February 1, 2025, and August 31, 2025.

More than half of the suzetrigine prescriptions ordered since its approval in February 2025 were ordered in just July and August, indicating an uptick in prescribing of this new medication, as seen in Figure 1. Over the same period, opioid prescriptions were evenly distributed.

Most prescriptions for suzetrigine (49%) were written for fewer than 31 tablets, as seen in Figure 2. Meanwhile, 58% of opioid prescriptions were written for fewer than 31 tablets. Suzetrigine prescriptions had higher rates of prescriptions with 31 to 60 tablets (25% vs. 15%) and greater than 120 tablets (11% vs. 6%) compared to opioid prescriptions.

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

1. U.S. Department of Health and Human Services. Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. Washington, DC: HHS; 2019. https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf. Accessed October 3, 2025.
2. FDA approves novel non-opioid treatment for moderate to severe acute pain. U.S. Food and Drug Administration. January 30, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-novel-non-opioid-treatment-moderate-severe-acute-pain. Accessed October 3, 2025.

We studied 24,235,834 women aged 50 to 65 who had a healthcare encounter and any active prescription between January 1, 2018, and September 30, 2025. Women were considered to be receiving hormone replacement therapy if they had a prescription for a medication commonly used for HRT, either new or renewed, during the specified quarter.

The quarterly rate of HRT prescribing remained stable from early 2018 through 2019, averaging around 33 HRT prescriptions per 1,000 women studied. A decline was observed in early 2020, coinciding with widespread disruptions to routine care during the COVID-19 pandemic. Rates remained below pre-pandemic levels through 2021 before beginning a steady upward trend. From Q2 2021 (29.3 per 1,000) to Q3 2025 (50.4 per 1,000), HRT prescribing rose 72%, with the largest growth occurring in the most recent quarters.

These findings suggest a growing clinical usage of HRT use among menopausal women in recent years, potentially reflecting updated clinical guidance and shifting perceptions of benefit-risk balance.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

1. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. doi:10.1097/GME.0000000000002200
2. FDA requests labeling changes related to safety information to clarify the benefit/risk considerations for menopausal hormone therapies. U.S. Food and Drug Administration. November 10, 2025. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations. Accessed November 11, 2025.

We studied 36,674 women aged 18 to 50 with a diagnosis of PCOS who filled a new prescription for either a GLP-1 or metformin between January 2021 and November 2024. Patients were required to have at least one baseline measurement of weight or HbA1c within a year before drug initiation and one follow-up measurement between 9 and 15 months after initiation.

At one year, patients with PCOS on GLP-1s experienced significantly greater weight loss than those on metformin. The median weight change among GLP-1 users was an 11.5% reduction, compared to a 1.9% reduction for metformin users. Many GLP-1 patients (55.7%) lost over 10% of their body weight, while only 13.7% of metformin patients reached that threshold.

For glycemic outcomes, the distribution of absolute HbA1c changes showed greater reductions for GLP-1 users compared to metformin users, as seen in Figure 2. A lower HbA1c is a marker of better blood glucose regulation, with a value below 5.7% representing normal glucose levels, a value between 5.7% and 6.4% representing prediabetes, and a value over 6.4% representing diabetes.³ Patients on GLP-1s had a median HbA1c reduction of 0.5 points, while those on metformin had a median HbA1c reduction of 0.1 points. 83.5% of patients who received GLP-1s had a reduction of their HbA1c, while only 55.9% of those who received metformin did.

A sensitivity analysis accounting for factors such as demographics, starting BMI classification, residence in a socially vulnerable area, comorbidities, and baseline HbA1c level also found that patients on GLP-1s were more likely to experience weight loss and to reduce their HbA1c levels.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. doi:10.1210/clinem/dgad463
2. Lin S, Deng Y, Huang J, et al. Efficacy and safety of GLP-1 receptor agonists on weight management and metabolic parameters in PCOS women: a meta-analysis of randomized controlled trials. Sci Rep. 2025;15(1):16512. Published 2025 May 13. doi:10.1038/s41598-025-99622-4
3. Ellis RR. Hemoglobin A1c (HbA1c): What to know if you have diabetes or prediabetes or are at risk for these conditions. Harvard Health. June 30, 2025. https://www.health.harvard.edu/diseases-and-conditions/hemoglobin-a1c-hba1c-what-to-know-if-you-have-diabetes-or-prediabetes-or-are-at-risk-for-these-conditions. Accessed November 5, 2025.

We studied 42,144 children born between January 1, 2010, and December 31, 2020, with follow-up through at least their fifth birthday. Children were included if they had a documented gestational age, a link to their mother’s chart, at least one outpatient face-to-face encounter at least every 18 months from birth through age 4.5, and at least one visit after age 5. We excluded children with neonatal abstinence syndrome or genetic abnormalities. We matched each child born to a mother with ICP to four children who were not exposed based on race, ethnicity, infant sex, delivery method, and whether they were diagnosed as small for their gestational age. We additionally accounted for prematurity, maternal age, multiple gestation, maternal comorbidities, social vulnerability, birth weight, and APGAR scores.

Motor delays and pervasive developmental delays were diagnosed in fewer than 4% of all children in the study. Speech and language delays were more common, with nearly 20% of all children studied having a speech or language delay diagnosis.

Compared with children who were not born to mothers diagnosed with ICP, those born to mothers diagnosed with ICP were 31% more likely to have a motor delay, 28% more likely to have a pervasive developmental disorder, and 19% more likely to have a speech or language delay by age 5.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

1. Lindor KD, Lee RH. Intrahepatic cholestasis of pregnancy. UpToDate. September 17, 2025. Accessed October 10, 2025. https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy

We studied 640,286 patients who were newly diagnosed with cancer between January 2015 and June 2022. We grouped patients as diagnosed during pre-pandemic (between January 1, 2015, and March 31, 2017) or during the COVID-19 pandemic (between March 11, 2020, and June 30, 2022) periods. Patients diagnosed before the COVID-19 pandemic were matched 4:1 with patients diagnosed during the pandemic period by sex, race, ethnicity, and age. We also accounted for social vulnerability, evidence of metastasis, and other comorbidities in our analysis.

Patients diagnosed with kidney cancer during the COVID-19 pandemic were 25% more likely to die from any cause within three years compared to those diagnosed before the pandemic, as seen in Figure 1. Pandemic-period lung cancer diagnoses were associated with an 11% increase in three-year all-cause mortality for patients diagnosed with lung cancer during the pandemic, while there was a 7% increase in three-year all-cause mortality for those diagnosed with breast cancer during the pandemic compared to those diagnosed prior to the pandemic.

These findings suggest that disruptions in care during the pandemic had measurable adverse effects on outcomes across multiple cancer types.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

1. Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors. JCO Clin Cancer Inform. 2020;4:1059-1071. doi:10.1200/CCI.20.00134
2. Jabbal IS, Sabbagh S, Dominguez B, et al. Impact of COVID-19 on Cancer-Related Care in the United States: An Overview. Curr Oncol. 2023;30(1):681-687. Published 2023 Jan 4. doi:10.3390/curroncol30010053
3. Epic Research. Delayed Cancer Screenings. Epic Research. https://epicresearch.org/articles/delays-in-preventive-cancer-screenings-during-covid-19-pandemic. Accessed on October 31, 2025.

This fall, the increase in cases has been particularly dramatic. Cases of medically attended HFMD reached 221.8 cases per 100,000 patients the week ending October 11, more than three times the peak rate in 2024 (76.3 cases per 100,000 patients) and nearly double the peak rate in 2023 (120.3 cases per 100,000 patients), as shown in figure 1.

While this rise has been seen across the United States, Tennessee has been particularly affected, with dozens of schools experiencing outbreaks,² as shown in figure 2. The rate in Tennessee between October 5 and October 18 was more than twice the national average (487 cases per 100,000 patients compared to 218 cases per 100,000 patients). Other states with rates much higher than the national average include Delaware (418 cases per 100,000 patients), Iowa (387 cases per 100,000 patients), and Georgia (378 cases per 100,000 patients).

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia.

1. Centers for Disease Control and Prevention. About Hand, Foot, and Mouth Disease. 2024 May 7. Accessed October 31, 2025. https://www.cdc.gov/hand-foot-mouth/about/index.html
2. Kekatos M. Hand, foot, and mouth disease outbreak hits 31 schools, day cares in Tennessee county. ABC News. October 22, 2025. Accessed October 31, 2025. https://abcnews.go.com/US/hand-foot-mouth-disease-outbreak-hits-31-schools/story?id=126752726

We studied the rate of firearm-related injury across more than 183 million emergency department (ED) visits in the U.S. between Q1 2018 and Q2 2025. Firearm injury diagnoses covered accidental, intentional, assault, undetermined, legal, and terrorism-related injuries.

Firearm injury rates rose sharply in Q2 2020 to 1.8 per 1,000 ED visits, doubling the Q2 2018 rate (0.9 per 1,000 ED visits). Rates declined in many quarters since and reached pre-pandemic levels by Q4 2023.

Firearm injury rates varied dramatically across age, sex, and racial/ethnic groups, with the highest rates concentrated among Black and Hispanic males aged 13 to 34. Black males aged 18 to 24 consistently experienced the highest injury rates. Before the COVID-19 pandemic, rates in this group remained below 15 per 1,000 ED visits in each quarter. However, rates in this group peaked at 25 per 1,000 ED visits in Q2 2020 and remained above 15 per 1,000 in many quarters since. Hispanic males in the same age group also had elevated rates during the pandemic, with a peak of 8.5 per 1,000 ED visits in Q3 2020, though rates have returned to pre-pandemic levels since.

Firearm injury rates also rose among female patients, particularly Black females aged 13 to 24, whose rates doubled during the pandemic and then declined some before stabilizing at levels higher than before 2020. However, firearm injury rates for Black females remain substantially lower than their male counterparts of the same age.

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 17,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Bohochik R, Lin L, Lindgren E, Thayer J, Teriakidis A. 2020 Firearm Injuries Up More Than 70%–Worse in Black and Hispanic Young Men. Epic Research. https://epicresearch.org/articles/2020-firearm-injuries-up-more-than-70-worse-in-black-and-hispanic-young-men. Accessed on September 3, 2025.

We studied more than 46 million adult patients across 49 U.S. states who had at least three outpatient visits between 2020 and 2025 to better understand patterns of Parkinson’s diagnoses. Data for Alaska were too sparse to conduct a meaningful analysis. We first examined the unadjusted incidence rates for each state and then calculated an adjusted rate that accounted for age, sex, and comorbidities.

When looking at unadjusted incidence rates, we found that Nebraska (620 per 100,000 patients) and Kansas (596 per 100,000 patients) had the highest rates of newly diagnosed Parkinson’s disease during the study period. States with the lowest observed rates were Montana (264 per 100,000 patients) and Nevada (275 per 100,000 patients).

After adjusting for patient age, time in the study, sex, race, ethnicity, and comorbidities, a relative rate was established for each state compared to Minnesota, the median for overall rates. Nebraska and Kansas remained the highest with 561 diagnoses per 100,000 patients and 517 diagnoses per 100,000 patients, respectively. Utah had the third highest rate at 493 diagnosed per 100,000 patients. States with the lowest relative rates were Montana (308 per 100,000 patients), Wisconsin (329 per 100,000 patients), and Washington (339 per 100,000 patients).

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Tanner CM, Ostrem JL. Parkinson’s disease. N Engl J Med. 2024;391(5):442-452. doi:10.1056/NEJMra2401857

We studied 246,775 pregnancies that occurred between January 1, 2017, and May 1, 2025, including those that had a miscarriage and those that did not, and matched pregnancies based on maternal age, gravidity, prior neonatal or fetal demise, and whether the pregnancy had more than one fetus. We accounted for demographics, BMI, smoking, rurality, census region, residence in a socially vulnerable area, multiple gestation status, maternal conditions, obstetric history, and prenatal care timing. Stillbirths were classified as early (20 to 27 weeks), late (28 to 36 weeks), or term (≥37 weeks).

Mothers who are Black experience markedly higher likelihood of stillbirths at each stage of stillbirth—up to 87% more likely compared to those who are White—as seen in Figure 1. A 9% increase in early pregnancy stillbirth was observed for Hispanic mothers. For other non-White mothers, representation was too low to establish statistical significance.

Mothers living in more rural areas are up to 35% more likely to experience a stillbirth compared to those living in more urban areas, as seen in Figure 2.

We evaluated 20 maternal conditions that could potentially influence the risk of stillbirth. Figure 3 shows those with the strongest correlation. Patients with diabetes consistently had increased likelihood of stillbirth across all stages. Mothers who had thrombophilia, severe obesity, hypertension, or chronic kidney disease (CKD), on the other hand, had varying relationships with the likelihood of stillbirth at different stages. For the results of all studied factors, see the tables in the PDF version of the brief.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Management of stillbirth: Obstetric care consensus no, 10: Obstetric care consensus no, 10. Obstet Gynecol. 2020;135(3):e110-e132. doi:10.1097/AOG.0000000000003719

To understand the relationship between GLP-1 medications and kidney function, as measured by creatinine lab results, we studied 108,439 adult patients who started semaglutide, liraglutide, or tirzepatide between 2021 and 2024 and had one or more creatinine labs in the months leading up to and following the new medication. Their change in creatinine was compared to patients with no GLP-1 exposure who had office visits in the same period. Patients prescribed GLP-1s were compared to patients who did not take GLP-1s but had similar patient demographics, baseline creatinine levels, follow-up period durations, and BMIs.

Among patients diagnosed with CKD, no statically significant changes in creatinine were seen for any of the medications, as shown in Figure 1. Among patients without CKD, minimal increases in serum creatinine were observed for patients on a GLP-1 compared to those who were not prescribed a GLP-1: 0.01 mg/dL for semaglutide, 0.01 mg/dL for liraglutide, and 0.02 mg/dL for tirzepatide. Normal creatinine levels are 0.5 to 1.1 mg/dL for females and 0.6 to 1.2 mg/dL for males.¹

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

1. Devkota, B. P. (2024, June 28). Creatinine. Medscape. https://emedicine.medscape.com/article/2054342-overview. Accessed August 1, 2025.
2. Li X, Song Y, Guo T, Xiao G, Li Q. Effect of glucagon-like peptide 1 receptor agonists on the renal protection in patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab. 2022;48(5):101366. doi:10.1016/j.diabet.2022.101366
3. Simental-Mendía M, Linden-Torres E, Sánchez-García A, Sahebkar A, Simental-Mendía LE. Effect of glucagon-like peptide-1 receptor agonists on renal function: A meta-analysis of randomized controlled trials. Br J Clin Pharmacol. 2022;88(8):3566-3576. doi:10.1111/bcp.15304