Healthcare utilization is a collider: an introduction to collider bias in EHR data reuse

Weiskopf, Nicole G.; Dorr, David A; Jackson, Christie; Lehmann, Harold P.; Thompson, Caroline A.

doi:10.1093/jamia/ocad013

Cited by 14 publications

(4 citation statements)

References 33 publications

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“…Future research should include the type, severity, and duration of arthritis while examining their influences on CMH. It would also be beneficial to have chart reviews [52] rather than self-report of a medical diagnosis of arthritis. Another limitation is the cross-sectional design of the study, not allowing for causal inferences to be made.…”

Section: Plos Onementioning

confidence: 99%

Flourishing mental health despite disabling chronic pain: Findings from a nationally representative sample of Canadians with arthritis

Fuller-Thomson,

Marshall,

Moses

et al. 2023

PLoS ONE

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This study aims to determine the prevalence of, and factors associated with, the “absence of psychiatric disorders” (APD) and “complete mental health” (CMH) among individuals with arthritis who report disabling chronic pain. There are three aspects of CMH: a) APD; b) happiness and/or life satisfaction in the past month on a daily or almost daily basis, and c) high levels of psychological and social well-being. A secondary analysis of a nationally representative sample (n = 620) of individuals with arthritis who report chronic and debilitating pain was conducted. Data were drawn from the Canadian Community Health Survey-Mental Health. The results of this study indicate that many people with arthritis who are living with disabling chronic pain are free of psychiatric disorders (76%) and are in CMH (56%). Factors associated with higher odds of APD and CMH among the sample include having a confidant, being free from insomnia, and having no lifetime history of major depressive disorder and/or generalized anxiety disorder. White respondents were almost 3-fold more likely to be in a state of CMH compared to racialized individuals. Respondents in the top 50% of household incomes were almost 4-fold more likely to be APD compared to the lowest 10%. In conclusion, many individuals with arthritis have excellent mental health despite disabling pain. Clinicians should be attuned to the mental health of their patients, with particular focus on those who may be more vulnerable to adverse mental health outcomes, such as racialized individuals, those in impoverished households, and those who lack social support.

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Section: Plos Onementioning

confidence: 99%

Flourishing mental health despite disabling chronic pain: Findings from a nationally representative sample of Canadians with arthritis

Fuller-Thomson,

Marshall,

Moses

et al. 2023

PLoS ONE

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“…DAGs are widely used in epidemiological research for their ability to visually represent known, assumed, or hypothesized relationships between variables, including risk factors, outcomes, and covariates. (11) DAGs can be used to guide study design and analyses and to identify potential biases. (12) They provide a structured framework to systematically evaluate and address these complexities, thereby enhancing the robustness and applicability of the research ndings.…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Diabetes Care and Outcomes for Patients with Visual Impairment: A Descriptive Analysis of the TriNetX Research Network

Madlock-Brown,

Lee,

Seltzer

et al. 2024

Preprint

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Background: This research delves into the confluence of racial disparities and health inequities among individuals with disabilities, with a focus on those contending with both diabetes and visual impairment. Methods: Utilizing data from the TriNetX Research Network, which includes electronic medical records of roughly 115 million patients from 83 anonymous healthcare organizations, this study employs a directed acyclic graph (DAG) to pinpoint confounders and augment interpretation. We identified patients with visual impairments using ICD-10 codes, deliberately excluding diabetes-related ophthalmology complications. Our approach involved multiple race-stratified analyses, comparing co-morbidities like chronic pulmonary disease in visually impaired patients against their counterparts. We assessed healthcare access disparities by examining the frequency of annual visits, instances of two or more A1c measurements, and glomerular filtration rate (GFR) measurements. Additionally, we evaluated diabetes outcomes by comparing the risk ratio of uncontrolled diabetes (A1c > 9.0) and chronic kidney disease in patients with and without visual impairments. Results: The incidence of diabetes was substantially higher (nearly double) in individuals with visual impairments across White, Asian, and African American populations. Higher rates of chronic kidney disease were observed in visually impaired individuals, with a risk ratio of 1.79 for African American, 2.27 for White, and non-significant for the Asian group. A statistically significant difference in the risk ratio for uncontrolled diabetes was found only in the White cohort (0.843). White individuals without visual impairments were more likely to receive two A1c tests, a trend not significant in other racial groups. African Americans with visual impairments had a higher rate of glomerular filtration rate testing. However, White individuals with visual impairments were less likely to undergo GFR testing, indicating a disparity in kidney health monitoring. This pattern of disparity was not observed in the Asian cohort. Conclusions: This study uncovers pronounced disparities in diabetes incidence and management among individuals with visual impairments, particularly among White, Asian, and African American groups. Our DAG analysis illuminates the intricate interplay between SDoH, healthcare access, and frequency of crucial diabetes monitoring practices, highlighting visual impairment as both a medical and social issue.

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“…Information about the receipt of cancer screening tests is widely available from patient data stored in electronic health records (EHR), a systematic collection of patient health information in a digital format [2]. Another alternative source of information about cancer screening is from patients' self-report, an arguably more cost-effective source [3]. EHRs may benefit both clinical and epidemiologic research, patient care, as well as performance measurement.…”

Section: Introductionmentioning

confidence: 99%

Comparison of health information exchange data with self-report in measuring cancer screening

Bhattacharyya¹,

Rawl²,

Dickinson³

et al. 2023

BMC Med Res Methodol

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Background Efficient measurement of the receipt of cancer screening has been attempted with electronic health records (EHRs), but EHRs are commonly implemented within a single health care setting. However, health information exchange (HIE) includes EHR data from multiple health care systems and settings, thereby providing a more population-based measurement approach. In this study, we set out to understand the value of statewide HIE data in comparison to survey self-report (SR) to measure population-based cancer screening. Methods A statewide survey was conducted among residents in Indiana who had been seen at an ambulatory or inpatient clinical setting in the past year. Measured cancer screening tests included colonoscopy and fecal immunochemical test (FIT) for colorectal cancer, human papilloma virus (HPV) and Pap tests for cervical cancer, and mammogram for breast cancer. For each screening test, the self-reported response for receipt of the screening (yes/no) and ‘time since last screening’ were compared with the corresponding information from patient HIE to evaluate the concordance between the two measures. Results Gwet’s AC for HIE and self-report of screening receipt ranged from 0.24–0.73, indicating a fair to substantial concordance. For the time since receipt of last screening test, the Gwet’s AC ranged from 0.21–0.90, indicating fair to almost perfect concordance. In comparison with SR data, HIE data provided relatively more additional information about laboratory-based tests: FIT (19% HIE alone vs. 4% SR alone) and HPV tests (27% HIE alone vs. 12% SR alone) and less additional information about procedures: colonoscopy (8% HIE alone vs. 23% SR alone), Pap test (13% HIE alone vs. 19% SR alone), or mammography (9% HIE alone vs. 10% SR alone). Conclusion Studies that use a single data source should consider the type of cancer screening test to choose the optimal data collection method. HIE and self-report both provided unique information in measuring cancer screening, and the most robust measurement approach involves collecting screening information from both HIE and patient self-report.

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Healthcare utilization is a collider: an introduction to collider bias in EHR data reuse

Cited by 14 publications

References 33 publications

Flourishing mental health despite disabling chronic pain: Findings from a nationally representative sample of Canadians with arthritis

Flourishing mental health despite disabling chronic pain: Findings from a nationally representative sample of Canadians with arthritis

Racial Disparities in Diabetes Care and Outcomes for Patients with Visual Impairment: A Descriptive Analysis of the TriNetX Research Network

Comparison of health information exchange data with self-report in measuring cancer screening

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