To determine whether the COVID-19 pandemic influenced AAA screening rates, we studied 5,513,347 men aged 65 to 75 with a smoking history and no prior AAA screening who had at least one face-to-face encounter between January 2017 and December 2023. We found that screening rates trended upward from the first quarter of 2017 through the fourth quarter of 2019, going from 591 per 100,000 eligible patients to 885 per 100,000 eligible patients being screened. Then, rates dropped by more than half to 403 per 100,000 eligible patients in the second quarter of 2020. Since then, rates have trended upward again, surpassing the pre-pandemic rates and reaching 1,102 per 100,000 eligible patients in the fourth quarter of 2023, an increase of 86% from the start of the study period. 

We used the screening rate from the fourth quarter of 2019 to forecast an expected AAA screening rate through the first quarter of 2021. Based on this projection, we estimate that at least 13,600 AAA screenings were missed in the Cosmos population between January 2020 and March 2021. It’s important to note that our forecasted screening rates assume that the pre-pandemic increase in screenings would not have continued beyond 2019, potentially leading to an underestimation in missed screenings. Therefore, our estimate should be considered a conservative lower limit on the number of screenings missed. 

To see how AAA screening rates compare to other types of screenings for this group of patients, we compared colorectal cancer screening rates from a previously published study to our AAA screening results. Colorectal cancer screening colonoscopies are recommended every 10 years for patients aged 45 to 75, which is a similar frequency and age group to those eligible for AAA screening.² That study showed, for patients over age 65, approximately 4,000 patients per 100,000 eligible were screened for colorectal cancer each quarter,³ which is more than triple the AAA screening rate observed in this study. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 245 million patient records from 1,400 hospitals and more than 32,500 clinics from all 50 states and Lebanon. 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. Abdominal Aortic Aneurysm: Screening. U.S. Preventative Services Task Force. Published December 10, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/abdominal-aortic-aneurysm-screening. Accessed March 5, 2024. 
2. U.S. Preventive Services Task Force. Colorectal cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Accessed April 11, 2024. 
3. Fox B, Joyce B, Allen S, Sahakian S. Colorectal Cancer Screening Rates on the Rise Following Guideline Expansion. Epic Research. https://epicresearch.org/articles/colorectal-cancer-screening-rates-on-the-rise-following-guideline-expansion. Accessed on April 11, 2024. 

We analyzed the incidence of ischemic stroke in a cohort of 3.9 million AFib patients, comparing rates between patients with and without OSA. We observed a 27.4% higher rate of ischemic stroke within one year of initial AFib diagnosis in patients with OSA, as illustrated in Figure 1. 

In clinical practice, the CHA₂DS₂-VASc tool is widely used to assess the risk of adverse cardiovascular events, including stroke, in AFib patients. The tool assigns a risk score based on patient age, sex, and the presence of various health conditions. A higher score indicates a greater likelihood of adverse cardiovascular outcomes. Some researchers have proposed adding OSA to the CHA₂DS₂-VASc tool as an additional risk factor.⁴ 

However, stratifying patients by OSA diagnosis at each risk score did not change the relationship between CHA₂DS₂-VASc score and stroke risk. As expected, stroke rates increased as the risk score rose, but there was no statistically significant difference in stroke rates for patients with and without OSA at each risk score level, as shown in Figure 2.  

To evaluate the value of incorporating OSA as a risk factor for stroke, we added one point to a patient’s CHA₂DS₂-VASc score when OSA was present. This is in line with currently proposed methods.⁵ Doing so, however, did not increase the model’s accuracy. This suggests that while ischemic stroke is more common among AFib patients with OSA compared to those without OSA, the existing CHA₂DS₂-VASc score components adequately capture this risk. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 243 million patient records from 1,400 hospitals and more than 32,500 clinics from all 50 states and Lebanon. 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 Aishwarya Shettigar.

1. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046-1053. doi:10.1016/S0140-6736(05)71141-7 
2. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-988. doi:10.1161/01.str.22.8.983 
3. Marulanda-Londoño E, Chaturvedi S. The Interplay between Obstructive Sleep Apnea and Atrial Fibrillation. Front Neurol. 2017 Dec 11;8:668. doi: 10.3389/fneur.2017.00668. PMID: 29312113; PMCID: PMC5732262. 
4. Goudis C, Daios S, Korantzopoulos P, Liu T. Should we incorporate obstructive sleep apnea in CHA2DS2-VASc score?. Sleep Breath. 2021;25(4):2099-2101. doi:10.1007/s11325-021-02305-3 
5. Yazdan-Ashoori P, Baranchuk A. Obstructive sleep apnea may increase the risk of stroke in AF patients: refining the CHADS2 score. Int J Cardiol. 2011;146(2):131-133. doi:10.1016/j.ijcard.2010.10.104 

To understand the relationship between montelukast and these mental health side effects, we studied 2,596,595 million patients prescribed montelukast or an inhaled corticosteroid for the first time between January 2017 and December 2022. We then examined whether the patients had a documented diagnosis of agitation, aggression, depression, or suicidal ideation within 14 months following their initial prescription.  

We found no significant difference in the likelihood of suicidal ideation, depression, agitation, or aggression for children aged 6 to 17 prescribed montelukast compared to those on an inhaled corticosteroid. The likelihood of agitation or aggression increased 15% among the 6- to 11-year-olds and 9% among the 12- to- 17-year-olds on montelukast, though those increases were not statistically significant. Depression was 8% more likely in those aged 6 to 11 prescribed montelukast than in those of the same age prescribed inhaled corticosteroids, but this increase was also not statistically significant.  

Among adult patients aged 18 to 30, the likelihood of depression was reduced by 9% and the likelihood of suicidal ideation was reduced by 26% compared to those on corticosteroids. Our findings may underrepresent the true incidence of these side effects as only those who sought care and received a diagnosis for the mental health condition were included. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 243 million patient records from 1,400 hospitals and more than 32,500 clinics from all 50 states and Lebanon. 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 requires Boxed Warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis. U.S. Food and Drug Administration. Published March 13, 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requires-boxed-warning-about-serious-mental-health-side-effects-asthma-and-allergy-drug. Accessed March 13, 2024. 
2. Jewett C, Mueller B. The F.D.A. Warned an Asthma Drug Could Induce Despair. Many Were Never Told. The New York Times. https://www.nytimes.com/2024/01/09/health/fda-singulair-asthma-drug-warning.html. Published January 9, 2024. Accessed March 13, 2024. 

To better understand how breast cancer and second primary lung cancer might be correlated, we studied 2,071,295 women aged 50–84 who received a screening mammogram between 2010 and 2023. Patients with an elevated breast cancer risk as evidenced by a previous breast or lung cancer diagnosis, a screening less than three months prior, or starting screening mammograms prior to age 50 were excluded. We assessed the rate of primary lung cancer in the five years following the screening mammogram among patients who received a breast cancer diagnosis and compared it with the rate of lung cancer in patients who did not receive a breast cancer diagnosis. We found that the five-year risk of lung cancer was doubled in the patients with breast cancer compared to those without, as shown in Figure 1. 

We then further stratified the breast cancer population by the type of treatment received following the breast cancer diagnosis. Patients who received multiple forms of treatment are included in each category. We found that breast cancer patients who received chemotherapy were the most likely to be diagnosed with subsequent primary lung cancer compared to breast cancer patients who received radiation or endocrine therapies, as shown in Figure 2. A sensitivity analysis using a Cox proportional hazards model yielded similar results. 

These findings suggest that patients diagnosed with breast cancer are at an increased risk of developing second primary lung cancer. Additional monitoring, such as lung cancer screening, may be warranted in patients with a previous history of breast cancer, especially if previous treatment included chemotherapy. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 243 million patient records from 1,400 hospitals and more than 32,500 clinics from all 50 states and Lebanon. This study was completed in collaboration with researchers from Rush University Medical Center and Vanderbilt University Medical Center. This study was completed by two teams that worked independently, each composed of clinicians and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

1. Wang R, Yin Z, Liu L, et al. Second Primary Lung Cancer After Breast Cancer: A Population-Based Study of 6,269 Women. Front Oncol. 2018;8:427. Published 2018 Oct 9. doi:10.3389/fonc.2018.00427 
2. Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist. 2007;12(1):20-37. doi:10.1634/theoncologist.12-1-20 

To better understand the incidence and potential implications of inaccurate pulse oximeter oxygen saturation readings, we studied 13,483 patients hospitalized between January 1, 2016, and November 9, 2023, who had a documented pulse oximeter reading (SpO2) followed by a blood gas oxygen saturation result (SaO2) within five minutes. We stratified patients by race and compared the rates of inconsistent SpO2 and SaO2 readings.

The FDA currently states that pulse oximeters are considered meeting accuracy requirements if SpO2 readings are within 2-4% of SaO2 readings.² We found that 24.7% of non-Hispanic Black patients had SpO2 readings that were at least five percentage points greater than their SaO2 readings compared to 19.0% of non-Hispanic White patients. Additionally, 10.2% of non-Hispanic Black patients had SpO2 readings at least 15 percentage points greater than their SaO2 readings compared to 7.3% of non-Hispanic White patients.

One of the primary concerns of inaccurate SpO2 readings is the potential for a delay in treatment. Providers often order supplemental oxygen or other treatment when oxygen saturation drops below 88%. If an SpO2 reading shows a value of 92% or greater but does not accurately reflect the patient’s actual oxygen saturation, there may be a delay in potentially life-saving treatment, which could result in significant risk to the patient. For this study, we considered patients to have occult hypoxemia when the patient had an SaO2 value less than or equal to 88%, but an SpO2 value of 92% or greater. We compared the incidence of occult hypoxemia for non-Hispanic Black and White patients and found that Black patients are 31.9% more likely to experience occult hypoxemia than White patients, as shown in Figure 2.

These results support the need for further investigation of pulse oximeter accuracy to account for differences in patient skin pigmentation, race, and ethnicity as suggested by the FDA.¹

These data come from Cosmos, a collaboration of Epic health systems representing more than 238 million patient records from 1,345 hospitals and more than 28,000 clinics from all 50 states and Lebanon. This study was completed by two teams that worked independently and was completed in collaboration with researchers from the University of Maryland Medical System, University of Maryland School of Medicine, and Federation of American Scientists. The two teams came to similar conclusions. Graphics by Kayla Monnette. 

1. Shuren J. CDRH takes steps to advance further discussions on pulse oximeters. U.S. Food and Drug Administration. Published November 17, 2023.  https://www.fda.gov/medical-devices/medical-devices-news-and-events/cdrh-takes-steps-advance-further-discussions-pulse-oximeters. Accessed January 9, 2024.
2. Pulse oximetry. Yale Medicine. Published January 3, 2023.  https://www.yalemedicine.org/conditions/pulse-oximetry. Accessed January 9, 2024.

To better understand how different GLP-1 medications, routes, and dosages might influence weight change, we studied 413,557 patients who were prescribed tirzepatide, liraglutide, dulaglutide, or injectable or oral semaglutide for a minimum of 180 days. We stratified patients by the peak dosage of the medication prescribed within the year of GLP-1 treatment to determine how dosage might influence the amount of weight loss experienced. We found that higher dosages of all GLP-1 medications studied were associated with greater median weight loss a year after starting the medication, as seen in Figure 1. Patients on tirzepatide experienced greater weight loss than those on liraglutide, dulaglutide, oral semaglutide, and all but the highest dose of injectable semaglutide. Patients on injectable semaglutide achieved greater median weight loss than patients prescribed oral semaglutide. 

The study population includes both diabetic and non-diabetic patients. Some of the medications and dosages studied, including oral semaglutide, dulaglutide, the 0.6 mg dosage of liraglutide, and the 1 mg and 2 mg dosages of injectable semaglutide, have not been approved by the FDA for the treatment of obesity.^1,2,3 As such, the patients prescribed these medications are much more likely to have been prescribed these medications for diabetes management compared to the patients prescribed the medications and dosages approved for weight loss. This may explain some of the differences observed in the median percentage of weight loss seen across the different medications and dosages. 

These data come from Cosmos, a collaboration of Epic health systems representing more than 238 million patient records from 1,345 hospitals and more than 28,975 clinics from all 50 states and Lebanon. 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 Kayla Monnette.

1. Little D, Deckert J, Bartelt K, Ganesh M, Stamp T. Weight Change with Semaglutide. Epic Research. https://epicresearch.org/articles/diabetes-drug-helps-with-weight-loss-in-both-diabetics-and-non-diabetics. Accessed March 6, 2024. 
2. FDA Approves New Medication for Chronic Weight Management. U.S. Food and Drug Administration. Published November 8, 2023.  https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management. Accessed March 6, 2024. 
3. FDA Approves Weight Management Drug for Patients Aged 12 and Older. U.S Food and Drug Administration. Published December 4, 2020. FDA approves weight management drug for patients aged 12 and older | FDA. Accessed March 6, 2024. 

We found that fentanyl testing rates in ED overdose encounters have risen across all age groups, tripling for most between Q1 2021 and Q4 2023, as seen in Figure 1. Patients aged 13 to 17 experienced the greatest increase in testing rates during this period, going from 5% of overdose encounters having a fentanyl screening to 26%. Patients aged 35 to 64 had the highest fentanyl positivity rate in all quarters, closely followed by those aged 18 to 34.

We also evaluated fentanyl toxicology testing and positivity by the patient’s rural-urban classification (RUCA). We found that fentanyl testing in urban areas occurred twice as often compared to rural areas in most quarters studied, with patients living in rural areas being tested for fentanyl in 9% of overdose encounters in Q4 2023 and patients living in urban areas being tested 20% of the time. However, the positivity rate for patients living in urban and rural areas has remained similar over the years.

Even with the increase in testing rates over recent years, positivity rates have remained fairly steady, indicating that the additional testing now is catching positive cases that could have been missed in the past.

These data come from Cosmos, a collaboration of Epic health systems representing more than 238 million patient records from 1,371 hospitals and more than 31,000 clinics from all 50 states and Lebanon. 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. The two teams came to similar conclusions. Graphics by Brian Olson.

1. Little DR, Deckert J, Barkley E et al. Only 5% of Overdose Patients Tested for Fentanyl, #1 Killer of Americans 18-45. Epic Research. https://epicresearch.org/articles/only-5-of-overdose-patients-tested-for-fentanyl-1-killer-of-americans-18-45. Accessed on January 18, 2024.
2. Bill Text – SB-864 General acute care hospitals: drug screening. Legislature.ca.gov. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB864.. Accessed February 5, 2024
3. Legislation – SB0914. Maryland.gov. https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/sb0914?ys=2023RS. Accessed February 5, 2024.
4. 2023 Act 43. Pennsylvania General Assembly. https://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2023&sessInd=0&act=43. Accessed February 5, 2024.
5. Fentanyl and Opiate Toxicology in Emergency Department Overdoses. Epic Research. https://www.epicresearch.org/data-tracker/fentanyl-and-opiate-toxicology. Accessed March 6, 2024.

To assess whether a change in maternal BMI influences the likelihood of obesity in her child, we studied the change in maternal BMI category from before pregnancy to at least six months after pregnancy and whether the child reached an obese BMI category after the age of two. We adjusted for the mother’s history of type 2 diabetes, age, race, BMI category before pregnancy, and social vulnerability. We also adjusted for gestational age at birth and sex of the child. Childhood obesity was defined as a BMI greater than the 95^th percentile for the child’s sex and age. Maternal obesity was defined as a BMI greater than 30, overweight was defined as a BMI between 25 and 30, and not overweight was defined as a BMI under 25.

We found that children born to mothers classified as obese both before and after pregnancy have a 146% increased likelihood of being obese compared to children born to mothers classified as not overweight both before and after pregnancy. However, for children born to mothers who are obese before pregnancy and overweight after pregnancy, the likelihood is reduced by 51 percentage points, to 95%. Similarly, children born to mothers classified as overweight before and after pregnancy have a 53% increased likelihood of being obese, but if the mother is not overweight after pregnancy, the child’s likelihood of obesity is reduced by eight percentage points, to 45%.

We also looked at the relationship between childhood obesity and a mother gaining weight at least six months after pregnancy, leading to an increased BMI category. We found that the child’s likelihood of being obese increased by 33 and 30 percentage points when their mother went from not overweight to overweight or from overweight to obese, respectively.

Although there is a correlation between BMI reduction after pregnancy and a decreased risk of obesity in the child, it is important to note that the mother’s BMI prior to pregnancy remains a stronger predictor of the child’s likelihood of obesity.

These data come from Cosmos, a collaboration of 239 Epic health systems representing more than 238 million patient records from 1,345 hospitals and more than 28,000 clinics from all 50 states and Lebanon. 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 Mark LeBay.

1. Reduce the proportion of children and adolescents with obesity — NWS‑04. Health.gov. Reduce the proportion of children and adolescents with obesity — NWS‑04 – Healthy People 2030 | health.gov. Accessed February 28, 2024.
2. Voerman E, Santos S, Patro Golab B, Amiano P, Ballester F, Barros H, et al. (2019) Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data meta-analysis. PLoS Med 16(2): e1002744. https://doi.org/10.1371/journal.pmed.1002744
3. Liao XP, Yu Y, Marc I, et al. Prenatal determinants of childhood obesity: a review of risk factors. Can J Physiol Pharmacol. 2019;97(3):147-154. doi:10.1139/cjpp-2018-0403
4. Mannino A, Sarapis K, Moschonis G. The Effect of Maternal Overweight and Obesity Pre-Pregnancy and During Childhood in the Development of Obesity in Children and Adolescents: A Systematic Literature Review. Nutrients. 2022; 14(23):5125. https://doi.org/10.3390/nu14235125

To investigate whether the policy statement or the COVID pandemic correlated with changes in pain management prescribing in the ED, we studied the proportion of ED encounters for pain-related chief complaints that included a medication administration of acetaminophen, ibuprofen, ketorolac, or a parenteral or oral opioid from 2014 to 2023.

We found that the proportion of pain-related ED encounters that included a parenteral opioid administration decreased after the publication of ACEP’s recommendation from 23.6% of encounters in July 2017 to 21.6% in May 2018. That rate increased slightly but remained steady until the COVID-19 pandemic in March 2020 led to an increase in the acuity of patients who were presenting to the ED.³ In April 2020, the rate of encounters with a parenteral opioid administration was 22.6%, and that rate remained higher than pre-pandemic levels at 26.4% of pain-related ED encounters in December 2023.

The rate of pain-related ED encounters with an oral opioid administration, including opioid combination medications, decreased prior to the ACEP’s policy statement in 2017 and after the release of the statement. The rate of encounters with an oral opioid administration has remained steady since 2020.

Ibuprofen administrations occurred for around 8% of ED encounters from 2014 to the start of the COVID-19 pandemic and then dropped to 6.4% of encounters in April 2020, concurrent with early concerns about NSAIDs and COVID-19.⁴ The percentage of encounters with ibuprofen administrations has increased slightly since that initial pandemic drop, but it remains lower than pre-pandemic levels at 7.5% of encounters in December 2023.

Acetaminophen and ketorolac administrations have increased since 2017, and rates of administrations dropped only slightly for these two types of pain medications at the start of the pandemic. Rates of encounters with acetaminophen and ketorolac administrations quickly returned to pre-pandemic rates in late 2020 and continued to gradually increase to 15.3% and 16.5% of ED encounters respectively in December 2023.

A sensitivity analysis limiting to only ED encounters that resulted in hospital admissions showed similar rates of medication administrations across all medication types studied.

While nonopioid medication administrations have increased since the ACEP’s policy statement in 2017, parenteral opioid administrations continue to be the most commonly administered pain medication for pain-related ED encounters. Ongoing monitoring of trends in ED administration of pain medications is warranted to evaluate ED clinical practice and the effort to balance effective pain management with patient and population concerns.

Original Publication Date: March 1, 2024
Last Updated: March 14, 2024

These data come from Cosmos, a collaboration of Epic health systems representing more than 238 million patient records from 1,345 hospitals and more than 28,000 clinics from all 50 states and Lebanon. 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. This study was done in collaboration with researchers from NYU Langone Health. Graphics by AJ Hinkens.

1. Downey LV, Zun LS. Pain management in the emergency department and its relationship to patient satisfaction. J Emerg Trauma Shock. 2010;3(4):326-330. doi:10.4103/0974-2700.70749
2. American College of Emergency Physicians. Policy Statement: Optimizing the Treatment of Acute Pain in the Emergency Department. Published April 2017. optimizing-the-treatment-of-acute-pain-in-the-ed.pdf (acep.org). Accessed February 28, 2024.
3. Alban C, Barkley E, Cox C. Sicker Patients, More Admissions: How COVID-19 has Changed Emergency Care. Epic Research. https://epicresearch.org/articles/sicker-patients-more-admissions-how-covid-19-has-changed-emergency-care. Accessed on February 14, 2024.
4. World Health Organization. The use of non-steroidal anti-inflammatory drugs (NSAIDS) in patients with COVID-19. Published April 2020. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with COVID-19 (who.int). Accessed February 28, 2024.

To better understand the potential relationship between GLP-1 medications and mental health diagnoses after starting the medications, we studied 3,081,254 diabetic patients and 929,174 non-diabetic patients. We adjusted for patient age, sex, and history of depression or anxiety. For the diabetic population, we also adjusted for HbA1c level and use of other diabetic medications. For the non-diabetic population, we adjusted for BMI classification. For the diabetic population, we compared patients prescribed GLP-1 medications to patients with an HbA1c level documented. For the non-diabetic population, we compared patients prescribed GLP-1 medications to patients prescribed a non-GLP-1 weight management medication. 

We first investigated the correlation between GLP-1 medications and depression diagnosis after starting the medication. Among diabetic patients, those prescribed any of the GLP-1 medications studied, except for liraglutide, showed a decreased likelihood of depression compared to those not prescribed the GLP-1 medication. Tirzepatide showed the greatest reduction in likelihood of depression for diabetic patients (65%), as shown in Figure 1. Among non-diabetic patients, those prescribed semaglutide had a lower likelihood of depression compared to those not prescribed the GLP-1 medication. Liraglutide showed no statistically significant difference in depression diagnoses for non-diabetic patients. 

Next, we evaluated the relationship between GLP-1 medications and anxiety. Similar to depression, diabetic patients prescribed any of the GLP-1 medications had a lower likelihood of being diagnosed with anxiety after starting the medication compared to those not prescribed a GLP-1 medication. Tirzepatide showed the greatest reduction in likelihood, with a 60% reduction, as seen in Figure 2. Among non-diabetic patients, only those prescribed semaglutide had a lower likelihood of anxiety compared to those not prescribed the GLP-1 medication, while those prescribed liraglutide had no statistically significant difference. 

These data come from Cosmos, a collaboration of Epic health systems representing more than 233 million patient records from 1,325 hospitals and more than 28,900 clinics from all 50 states and Lebanon. 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. Update on FDA’s ongoing evaluation of reports of suicidal thoughts or actions in patients taking a certain type of medicines approved for type 2 diabetes and obesity. U.S. Food and Drug Administration. Published January 11, 2024. https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type. Accessed January 16, 2024. 
2. Common Side Effects of Wegovy®. Wegovy. https://www.wegovy.com/taking-wegovy/side-effects.html. Accessed January 16, 2024. 
3. Possible Side Effects of Ozempic® (semaglutide) Injection. Ozempic. https://www.ozempic.com/how-to-take/side-effects.html. Accessed January 26, 2024.