310004
New sources of data for public health: Using electronic health records to examine population obesity and smoking prevalence and variation
OBJECTIVE: We used data from electronic health records (EHR) to determine the rate of obesity and tobacco use in our service area, and to examine variability from year to year.
METHODS: Height, weight, gender, age, smoking status, insurance type and appointment type were obtained from electronic health records (EHRs) for 156,744 adult patients seen in 2012-2013 within a Wisconsin healthcare system. Analysis examined variability by patient characteristics.
RESULTS: BMI and tobacco were available for 91.5% and 94.8% in 2012; and 94.5% and 97% in 2013. The obesity rate was 41.7% in 2012 and 42.0% in 2013 (much higher than national rates); 16.5% were smokers in 2012, 15.7% in 2013 (much lower than national rates). Obesity varied by age (61-70), gender (female), and insurance type (government). Tobacco use varied by age (31-40), gender (male), and insurance type (none). Average change in weight for those present both years was a 0.01 kg gain. About half the patient’s weights remained the same; 24.8% lost (average -3.60 kg), 26.7% gained (+3.34 kg). The largest gain was among the underweight (+1.46 kg), and largest loss among the obese III (-1.16 kg). In multivariate analysis, weight change was related to age, insurance type and BMI. Those presenting for care only one year were less likely to be obese (37.2%), but more likely to use tobacco (21.5%).
DISCUSSION – Data from an EHR can provide more accurate observations. While understanding biases from national surveys of health behavior, it is important to understand variation in patient data, as well. Obesity may be overestimated from EHR, while tobacco use may be underestimated. This information can be helpful in developing effective community health improvement plans.
Learning Areas:
Assessment of individual and community needs for health educationChronic disease management and prevention
Clinical medicine applied in public health
Epidemiology
Program planning
Public health or related research
Learning Objectives:
Evaluate the possibility of health system data to describe prevalence and variability in obesity and tobacco use.
Describe the variability and trade-offs in using health system data compared to national survey data.
Keyword(s): Obesity, Tobacco Use
Qualified on the content I am responsible for because: I have conducted and published research in obesity and smoking prevention and intervention. I am interested in obesity and tobacco use on a population level. I am the director of my health system's population health department.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.