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Al-Sahab B, Leviton A, Loddenkemper T, Paneth N, Zhang B. Biases in Electronic Health Records Data for Generating Real-World Evidence: An Overview. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2024; 8:121-139. [PMID: 38273982 PMCID: PMC10805748 DOI: 10.1007/s41666-023-00153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/05/2023] [Accepted: 11/07/2023] [Indexed: 01/27/2024]
Abstract
Electronic Health Records (EHR) are increasingly being perceived as a unique source of data for clinical research as they provide unprecedentedly large volumes of real-time data from real-world settings. In this review of the secondary uses of EHR, we identify the anticipated breadth of opportunities, pointing out the data deficiencies and potential biases that are likely to limit the search for true causal relationships. This paper provides a comprehensive overview of the types of biases that arise along the pathways that generate real-world evidence and the sources of these biases. We distinguish between two levels in the production of EHR data where biases are likely to arise: (i) at the healthcare system level, where the principal source of bias resides in access to, and provision of, medical care, and in the acquisition and documentation of medical and administrative data; and (ii) at the research level, where biases arise from the processes of extracting, analyzing, and interpreting these data. Due to the plethora of biases, mainly in the form of selection and information bias, we conclude with advising extreme caution about making causal inferences based on secondary uses of EHRs.
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Affiliation(s)
- Ban Al-Sahab
- Department of Family Medicine, College of Human Medicine, Michigan State University, B100 Clinical Center, 788 Service Road, East Lansing, MI USA
| | - Alan Leviton
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA USA
| | - Tobias Loddenkemper
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA USA
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI USA
| | - Bo Zhang
- Department of Neurology, Boston Children’s Hospital, Boston, MA USA
- Biostatistics and Research Design, Institutional Centers of Clinical and Translational Research, Boston Children’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Gregoriano C, Rafaisz K, Schuetz P, Mueller B, Fux CA, Conen A, Kutz A. Burden of disease in patients hospitalised with COVID-19 during the first and second pandemic wave in Switzerland: a nationwide cohort study. Swiss Med Wkly 2023; 153:40068. [PMID: 37190990 DOI: 10.57187/smw.2023.40068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
AIM OF THE STUDY The first and second waves of the COVID-19 pandemic led to a tremendous burden of disease and influenced several policy directives, prevention and treatment strategies as well as lifestyle and social behaviours. We aimed to describe trends of hospitalisations with COVID-19 and hospital-associated outcomes in these patients during the first two pandemic waves in Switzerland. METHODS In this nationwide retrospective cohort study, we used in-hospital claims data of patients hospitalised with COVID-19 in Switzerland between January 1st and December 31st, 2020. First, stratified by wave (first wave: January to May, second wave: June to December), we estimated incidence rates (IR) and rate differences (RD) per 10,000 person-years of COVID-19-related hospitalisations across different age groups (0-9, 10-19, 20-49, 50-69, and ≥70 years). IR was calculated by counting the number of COVID-19 hospitalisations for each patient age stratum paired with the number of persons living in Switzerland during the specific wave period. Second, adjusted odds ratios (aOR) of outcomes among COVID-19 hospitalisations were calculated to assess the association between COVID-19 wave and outcomes, adjusted for potential confounders. RESULTS Of 36,517 hospitalisations with COVID-19, 8,862 (24.3%) were identified during the first and 27,655 (75.7%) during the second wave. IR for hospitalisations with COVID-19 was highest during the second wave and among patients above 50 years (50-69 years: first wave: 31.49 per 10,000 person-years; second wave: 62.81 per 10,000 person-years; RD 31.32 [95% confidence interval [CI]: 29.56 to 33.08] per 10,000 person-years; IRR 1.99 [95% CI: 1.91 to 2.08]; ≥70 years: first wave: 88.59 per 10,000 person-years; second wave: 228.41 per 10,000 person-years; RD 139.83 [95% CI: 135.42 to 144.23] per 10,000 person-years; IRR 2.58 [95% CI: 2.49 to 2.67]). While there was no difference in hospital readmission, when compared with the first wave, patients hospitalised during the second wave had a lower probability of death (aOR 0.88 [95% CI: 0.81 to 0.95], ARDS (aOR 0.56 [95% CI: 0.51 to 0.61]), ICU admission (aOR 0.66 [95% CI: 0.61 to 0.70]), and need for ECMO (aOR 0.60 [95% CI: 0.38 to 0.92]). LOS was -16.1 % (95% CI: -17.8 to -14.2) shorter during the second wave. CONCLUSION In this nationwide cohort study, rates of hospitalisations with COVID-19 were highest among adults older than 50 years and during the second wave. Except for hospital readmission, the likelihood of adverse outcomes was lower during the second pandemic wave, which may be explained by advances in the understanding of the disease and improved treatment options.
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Affiliation(s)
- Claudia Gregoriano
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Kris Rafaisz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph A Fux
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Conen
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Agyekum RS, Abramoff BA, Wherry EJ, Meyer NJ. Building effective collaborations for the study of COVID-19 across the severity spectrum. Nat Immunol 2022; 23:1287-1290. [PMID: 35999396 DOI: 10.1038/s41590-022-01283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Roseline S Agyekum
- Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.,Center for Translational Lung Biology, Lung Biology Institute, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | - Benjamin A Abramoff
- Department of Physical Medicine and Rehabilitation, , University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | - E John Wherry
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.,Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.,Parker Institute for Cancer Immunotherapy, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | - Nuala J Meyer
- Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA. .,Center for Translational Lung Biology, Lung Biology Institute, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA. .,Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.
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Yeh WB, Lee WK, Chou MC, Jou IM. Comments on the Risk of Gout in Patients with Psoriasis [Letter]. Clin Epidemiol 2022; 14:849-850. [PMID: 35874906 PMCID: PMC9297038 DOI: 10.2147/clep.s379488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wen-Bin Yeh
- Emergency department, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Wei-Kai Lee
- Emergency Department, Sinying Hospital, Ministry of Health and Welfare, Tainan, Taiwan.,Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Mei-Chia Chou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Pingtung County, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan
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