We studied more than 2 million U.S. patients with an ED visit for an MVC and another 2 million U.S. patients with an ED visit for a fall between 2017 and November 11, 2025. Patients were excluded if they had a documented history of firearm injury, MVC, or fall before the ED visit of interest. Patients with an ED visit for an MVC were matched with patients whose ED visit was for a fall based on age, sex, race and ethnicity, census region, and month of the ED encounter. We additionally accounted for rurality based on residence, social vulnerability based on residence, ED acuity score, smoking history, prior health care utilization, and history of comorbidities including mental health conditions, traumatic brain injury, pervasive developmental disorders, and lead poisoning.

Across most census regions, male patients aged 10 to 15 experienced the clearest pattern of elevated firearm-injury risk following an ED visit for an MVC, with as much as four times as likely as those whose ED visit was for a fall, as seen in Figure 1. For male patients aged 16 to 25, the association persisted across many census regions but was smaller in magnitude; depending on region, patients were 81% more likely to have a firearm injury following an MVC compared to a fall.

Of note, significance was not observed for female patients or adults over age 25 in nearly all stratifications.

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, in collaboration with researchers from Children’s Wisconsin. The two teams came to similar conclusions. Graphics by Brian Olson.

1. Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med. 2018;379(25):2468-2475. doi:10.1056/NEJMsr1804754
2. Sims DW, Bivins BA, Obeid FN, Horst HM, Sorensen VJ, Fath JJ. Urban trauma: a chronic recurrent disease. J Trauma. 1989;29(7):940-947.

We studied 128,979 U.S. infants younger than 8 weeks old who had an emergency department (ED) visit between January 1, 2017, and September 30, 2025, and who had a blood, cerebrospinal fluid, or urine culture performed; a documented temperature during the visit; and a birth record in Cosmos. Infants were classified as having a low temperature (<36°C), normal temperature (36–38°C), or elevated temperature (>38°C) based on the lowest or highest temperature recorded during the visit. We then looked for an abnormal blood, cerebrospinal fluid, or urine culture as confirmation of a bacterial infection. Infants were grouped into those who were born prematurely (<37 weeks) or who had a NICU stay near the time of birth and those who were full term without a NICU stay. We accounted for social vulnerability based on residence, rurality based on residence, demographics, ED acuity level, census region of residence, and age group (birth to 3 weeks, 4 weeks, 5 to 8 weeks). Clinical guidelines for managing newborns with an abnormal temperature vary based on the infant’s age.⁴

Across all age groups, elevated temperature was a strong predictor of bacterial infection, whereas low temperature demonstrated an age-dependent pattern, as shown in Figure 1. Among 5- to 8-week-old infants, those with a low temperature were 42% more likely to have a bacterial infection if they were full term without a NICU stay and 53% more likely if they were preterm or had a NICU stay, compared with infants who had a normal temperature. Among 4-week-old infants, low temperature was not associated with a significant change in infection likelihood in either group. Among the youngest infants (birth to 3 weeks old), there was no clinically meaningful increase in infection likelihood with low temperature, which was associated with only a 9% increase in likelihood for full term infants without a NICU stay and a statistically insignificant increase for infants who were premature or had a NICU stay.

These findings suggest that low body temperature might be a meaningful predictor of bacterial infections for infants starting at 5 weeks old.

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, in collaboration with a researcher from UPMC Children’s Hospital of Pittsburgh. The two teams came to similar conclusions. Graphics by Brian Olson.

1. Ramgopal S, Lo YHJ, Potisek NM, Money NM, Halvorson EE, Cruz AT, Rogers AJ. Current Evidence on the Care of Young Infants With Hypothermia in the Emergency Department. Pediatr Emerg Care. 2025 Feb 1;41(2):146-151. doi: 10.1097/PEC.0000000000003259. PMID: 39883795.
2. Ramgopal S, Walker LW, Vitale MA, Nowalk AJ. Factors associated with serious bacterial infections in infants ≤60 days with hypothermia in the emergency department. Am J Emerg Med. 2019;37(6):1139-1143. doi:10.1016/j.ajem.2019.04.015
3. Ramgopal S, Noorbakhsh KA, Pruitt CM, Aronson PL, Alpern ER, Hickey RW. Outcomes of young infants with hypothermia evaluated in the emergency department. J Pediatr. 2020;221:132-137.e2. doi:10.1016/j.jpeds.2020.03.002
4. Fever in infants 0 to 60 days. Children’s Hospital Colorado. https://www.childrenscolorado.org/health-professionals/clinical-resources/clinical-pathways/fever-in-infants-0-to-60-days/. Accessed December 18, 2025.

We studied more than 2 million patients aged 15 to 49. We matched patients newly diagnosed with migraines between January 1, 2018, and December 31, 2023, with patients who had an office visit in the same month and who were of similar age, race, ethnicity, and hypertension status. We also accounted for social vulnerability and rurality based on residence, BMI classification, smoking history, prior pregnancy, and census region in our analysis. We ended the study period at the end of 2023 because oral contraceptives became available over the counter in 2024,² reducing our ability to reliably identify users.

We found that patients who used intrauterine progestin-only birth control were 24% less likely to have migraines diagnosed within two years compared to patients without a history of birth control use, as seen in Figure 1. Similarly, patients who were on oral progestin-only birth control were 18% less likely to be diagnosed with migraines within two years, those who were on intramuscular progestin-only birth control were 15% less likely, and those on other routes were 13% less likely.

Because this study included only individuals without prior migraines, the findings reflect association with new diagnoses rather than migraine progression.

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. MacGregor EA. Migraine and use of combined hormonal contraceptives: a clinical review. J Fam Plann Reprod Health Care. 2007;33(3):159-169. doi:10.1783/147118907781004750
2. FDA approves first nonprescription daily oral contraceptive. U.S. Food and Drug Administration. August 9, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive. Accessed December 11, 2025.

We studied adult patients first diagnosed with osteopenia or osteoporosis between 2017 and 2024. Patients were grouped into nondiabetic or type 2 diabetic cohorts, then each patient on a GLP-1 was matched to four patients who were not prescribed a GLP-1 based on age at bone density disorder diagnosis, total observed time with the condition, and number of prior fractures. Patients were excluded if they had GLP-1 exposure of less than six months. We additionally accounted for sex, race, ethnicity, BMI prior to starting the GLP-1, change in BMI upon starting the GLP-1 as well as throughout their usage, use of osteoporosis medications, steroid use, smoking history, and comorbidities including hyperparathyroidism, chronic falls, cancer, CKD, malabsorption, IBD, and eating disorders in our analysis.

Across both diabetic and nondiabetic cohorts, GLP-1s were associated with a meaningfully lower fracture risk. Among patients with type 2 diabetes, GLP-1 use was associated with a 32% lower risk of fracture for those with osteopenia and for those with osteoporosis, as seen in Figure 1. Among patients without diabetes, GLP-1 use was associated with a 34% lower risk of fracture for those with osteopenia and a 38% lower risk for those with osteoporosis.

The magnitude of risk reduction was slightly greater among non-diabetic patients, suggesting that the difference in fracture risk might be independent of glycemic control. However, this study did not assess bone mineral density (DEXA) results or lifestyle factors such as physical activity and nutrition, which might moderate fracture risk.

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. Paccou J, Compston JE. Bone health in adults with obesity before and after interventions to promote weight loss. Lancet Diabetes Endocrinol. 2024;12(10):748-760. doi:10.1016/S2213-8587(24)00163-3
2. Tan Y, Liu S, Tang Q. Effect of GLP-1 receptor agonists on bone mineral density, bone metabolism markers, and fracture risk in type 2 diabetes: a systematic review and meta-analysis. Acta Diabetol. 2025;62(5):589-606. doi:10.1007/s00592-025-02468-5
3. Su B, Sheng H, Zhang M, et al. Risk of bone fractures associated with glucagon-like peptide-1 receptor agonists’ treatment: a meta-analysis of randomized controlled trials. Endocrine. 2015;48(1):107-115. doi:10.1007/s12020-014-0361-4

We studied more than 1 million patients aged 20 years and older who initiated a lipid-lowering medication between January 1, 2016, and August 1, 2025. We accounted for patient demographics, comorbidities, use of other lipid-lowering medications in the past or concurrently, BMI, smoking status, rurality, and social vulnerability. The dosage of the medications prescribed was not accounted for.

Across all cholesterol-lowering medications, men experienced larger LDL reductions than women after starting therapy, as seen in Figure 1. The difference was consistent across every drug class, suggesting a systematic sex-based disparity in response rather than an isolated effect of any single treatment. The gap was most pronounced for PCSK9 inhibitors, where men showed a 7.3-percentage point greater decrease in LDL, and remained notable for statins and cholesterol absorption inhibitors, both showing about a 4–6 percentage point larger decline in men. Even among classes less directly associated with LDL lowering (such as fibric acid derivatives, bile acid sequestrants, and omega-3 fatty acid agents) men continued to demonstrate modestly greater reductions. Only the combination of ACLY plus cholesterol absorption inhibitor showed no meaningful difference between sexes.

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. Paquette M, Faubert S, Saint-Pierre N, Baass A, Bernard S. Sex differences in LDL-C response to PCSK9 inhibitors: A real world experience. J Clin Lipidol. 2023;17(1):142-149. doi:10.1016/j.jacl.2022.12.002
2. Silverman MG, Ference BA, Im K, et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: A systematic review and meta-analysis. JAMA. 2016;316(12):1289. doi:10.1001/jama.2016.13985
3. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: Executive summary: A report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation. 2019;139(25). doi:10.1161/cir.0000000000000624

We analyzed a random sampling of medication orders and dispenses for 5 million patients that occurred between January 1, 2022, and July 1, 2025, across key drug groups: antihypertensives for patients with hypertension, statins for those with hyperlipidemia, and diabetes therapies for those with type 2 diabetes. For primary adherence, we calculated the proportion of patients who had the medication dispensed within 30 days of the order. For secondary adherence, we used the mean possession ratio (MPR), which is the number of days the dispensed medication should last divided by the number of days in the follow-up period (up to one year). Patients with multiple insurance types were counted in all applicable buckets.

Commercially insured and Medicare Advantage patients demonstrated the highest primary adherence across all medication groups studied, while self-pay patients showed consistently lower rates, as seen in Figure 1. Specifically, commercially insured patients had the medication dispensed within 30 days 85% of the time for statins, 85% of the time for antihypertensives, and 78% of the time for diabetes medications. Adherence was slightly lower among Medicare Advantage, Medicaid, and Medicare patients. Self-pay patients had the medication dispensed within 30 days 68% of the time for statins, 66% of the time for antihypertensives, and 63% of the time for diabetes medications.

Next, we evaluated secondary adherence among patients who received at least two dispenses. Medicare and Medicare Advantage patients achieved secondary adherence rates around 88% for statins and antihypertensives and 82% for diabetes medications, reflecting strong persistence once treatment began. In contrast, self-pay patients averaged 74% for statins, 76% for antihypertensives, and 66% for diabetes medications.

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. 2024 Medicare Advantage and Part D Star Ratings. Centers for Medicare & Medicaid Services. October 13, 2023. https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-star-ratings. Accessed October 17, 2025.
2. PQA Adherence Measures. Pharmacy Quality Alliance. 5/2025. https://www.pqaalliance.org/adherence-measures. Accessed October 17, 2025.
3. Neiman AB, Ruppar T, Ho M, et al. CDC grand rounds: Improving medication adherence for chronic disease management – innovations and opportunities. MMWR Morb Mortal Wkly Rep. 2017;66(45):1248-1251. doi:10.15585/mmwr.mm6645a2

We studied 118,940 patients with type 1 or 2 diabetes who were newly prescribed injectable fast-acting insulin or inhaled insulin between January 2017 and May 2025. Patients were excluded if they had a history of smoking, asthma, COPD, or pregnancy during the study period to ensure all patients were eligible for either kind of insulin. All patients had a baseline HbA1c lab within the 12 months prior to the prescription, with the closest lab to the prescription being used if there were multiple. All included patients also had a follow-up HbA1c lab in the 3 to 12 months after the prescription was given.

We found that patients with type 1 diabetes who were prescribed inhaled insulin had an average HbA1c reduction of 0.68 percentage points, compared to 0.82 points for those on injectable insulin, as seen in Figure 1. For patients with type 2 diabetes, inhaled insulin users had an average reduction of 0.50 percentage points, while those on injectable insulin had a 0.46 percentage point reduction. Prior literature suggests a 0.5 percent point change in HbA1c between readings is considered significant.³

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. Fala L. Afrezza (Insulin Human) Inhalation Powder Approved for the Treatment of Patients with Type 1 or Type 2 Diabetes. Am Health Drug Benefits. 2015;8(Spec Feature):40-43.
2. American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: Standards of care in diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S181-S206. doi:10.2337/dc25-S009
3. Weykamp C. HbA1c: a review of analytical and clinical aspects. Ann Lab Med. 2013;33(6):393-400. doi:10.3343/alm.2013.33.6.393

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.