Linking electronic health records with community-level data to understand childhood obesity risk.
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ABSTRACT:
SUBMITTER: Tomayko EJ
PROVIDER: S-EPMC4492911 | biostudies-literature | 2015 Dec
REPOSITORIES: biostudies-literature
Publications
Linking electronic health records with community-level data to understand childhood obesity risk.
Tomayko E J EJ Flood T L TL Tandias A A Hanrahan L P LP
Pediatric obesity 20150105 6
<h4>Background</h4>Environmental and socioeconomic factors should be considered along with individual characteristics when determining risk for childhood obesity.<h4>Objectives</h4>To assess relationships and interactions among the economic hardship index (EHI) and race/ethnicity, age and sex in regard to childhood obesity rates in Wisconsin children using an electronic health record dataset.<h4>Methods</h4>Data were collected using the University of Wisconsin (UW) Public Health Information Exch ...[more]
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Project description:There is an urgent need for childhood surveillance systems to design, implement, and evaluate interventions at the local level. We estimated obesity prevalence for individuals aged 5-17 years using a southcentral Wisconsin EHR data repository, Public Health Information Exchange (PHINEX, 2007-2012). The prevalence estimates were calculated by aggregating the estimated probability of each individual being obese, which was obtained via a generalized linear mixed model. We incorporated the random effects at the area level into our model. A weighted procedure was employed to account for missingness in EHR data. A non-parametric kernel smoothing method was used to obtain the prevalence estimates for locations with no or little data (<20 individuals) from the EHR. These estimates were compared to results from newly available obesity atlas (2015-2016) developed from various EHRs with greater statewide representation. The mean of the zip code level obesity prevalence estimates for males and females aged 5-17 years is 16.2% (SD 2.72%); 17.9% (SD 2.14%) for males and 14.4% (SD 2.00%) for females. The results were comparable to the Wisconsin Health Atlas (WHA) estimates, a much larger dataset of local community EHRs in Wisconsin. On average, prevalence estimates were 2.12% lower in this process than the WHA estimates, with lower estimation occurring more frequently for zip codes without data in PHINEX. Using this approach, we can obtain estimates for local areas that lack EHRs data. Generally, lower prevalence estimates were produced for those locations not represented in the PHINEX database when compared to WHA estimates. This underscores the need to ensure that the reference EHRs database can be made sufficiently similar to the geographic areas where synthetic estimates are being created.
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Project description:ContextEarly childhood caries (ECC) is a persistent public health challenge, affecting more than 56% of US toddlers and preschool-aged children. Despite this, ECC is largely preventable with routine oral hygiene practices, diet, and application of topical fluoride.ObjectiveThis study assessed the utilization of preventive oral health care in primary care practices and evaluated the variation in patient characteristic and geographic disparities.DesignWe conducted a retrospective study using electronic health records (EHRs) over a 2-year period. Patients' home addresses were geocoded and linked to census-based neighborhood statistics and fluoridated water accessibility. Multiple logistic regression modeling was used to assess the risk of ECC in patients with fluoride preventive care, controlled for demographics, comorbid conditions, and neighborhood risk factors.ParticipantsPatients aged 6 to 71 months who had primary care providers at family medicine and general pediatric clinics in a large academic medical center.Main outcome measureThe presence of dental caries based on diagnoses in EHRs.ResultsThe study consisted of 10 836 patients: 17% treated with topical fluoride varnish (TFV), 12% prescribed oral fluoride supplement, 6.1% with both TFV and supplement, and 64% without fluoride treatment. Patients with fluoride treatment were 24% to 53% less likely to have ECC. Children living in rural and nonfluoridated water communities had 1.7 to 1.8 times greater risk of developing ECC. Minority, under/uninsured, and low-income patients also were at an increased risk of ECC.ConclusionDespite continuing efforts to improve access to dental care for vulnerable populations, substantial disparities remain among socioeconomically disadvantaged children. To address dental care shortage, primary care clinicians should serve as the safety net to care for vulnerable and underserved children who have no or limited access to oral health services. Future research into the collaboration between primary care and dental providers at the level of both practice and professional education should be considered.
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