Epic Research

Women on Antihypertensive Treatment Achieve Higher Rates of Blood Pressure Control Early in Treatment Than Men

Wed, 04 Jun 2025 11:00:00 +0000

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.

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.

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.

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
Reckelhoff JF. Gender differences in the regulation of blood pressure. Hypertension. 2001;37(5):1199-1208. doi:10.1161/01.hyp.37.5.1199
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
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.

Patient Portal Users Are More Likely to be Up to Date with Breast Cancer Screenings

Kersten Bartelt, RN; Emily Higgs; Matthew Gracianette, MD; Joe Deckert, PhD — Tue, 13 May 2025 11:00:00 +0000

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.

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.

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.

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.

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.
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

Surgical Site Infection Rates for Colorectal Surgery Have Increased 21% Since 2019

Kersten Bartelt, RN; Emily Higgs ; Matthew Gracianette, MD; Eric Barkley — Thu, 08 May 2025 11:00:00 +0000

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.

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.

Surgical site infection. World Health Organization. https://www.who.int/teams/integrated-health-services/infection-prevention-control/surgical-site-infection. Accessed April 15, 2025.
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.
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
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

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

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

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

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

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

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

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 298 million patient records from 1,700 hospitals and more than 39,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

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

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

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

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

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

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

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

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

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

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,700 hospitals and more than 39,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

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

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

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

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

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

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

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

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 39,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

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

Hurricanes Have Minimal Influence on Sinus Infection Rates

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

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

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

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

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

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

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 295 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

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