Leveraging a health information exchange for analyses of COVID-19 outcomes including an example application using smoking history and mortality

PLoS One. 2021 Jun 3;16(6):e0247235. doi: 10.1371/journal.pone.0247235. eCollection 2021.

Abstract

Understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 is critically important, and requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up. A large Health Information Exchange (HIE) in Southeast Texas, which assembles and shares electronic health information among providers to facilitate patient care, was leveraged to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes. The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic's onset to June 12th, 2020 and was created for the analyses shown here. We gathered demographic, lifestyle, laboratory, and clinical data from patient's encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities. Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, over 26% were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older (odds ratio = 1.07, 95% CI 1.06, 1.08), male (1.91, 95% CI 1.58, 2.31), and had a history of tobacco use (2.45, 95% CI 1.93, 3.11). History of tobacco use remained significantly associated (1.65, 95% CI 1.27, 2.13) with COVID-19 fatality after adjusting for age, gender, and race/ethnicity. This effort demonstrates the impact of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across disparate healthcare providers electronic health record (HER) systems, and follow the cohort over time. These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.

MeSH terms

  • Age Factors
  • COVID-19 / mortality*
  • Cohort Studies
  • Comorbidity
  • Ethnicity
  • Health Information Exchange / statistics & numerical data*
  • Health Information Exchange / trends*
  • Healthcare Disparities
  • Hospitalization
  • Humans
  • Pandemics
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2 / metabolism
  • SARS-CoV-2 / pathogenicity
  • Sex Factors
  • Smoking
  • Texas

Grants and funding

Greater Houston Healthconnect (GHH) provided support in the form of salaries for authors NB, AM, WC, and JM but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Greater Houston Healthconnect (GHH) is a not-for-profit, neutral entity, governed by a multi-stakeholder board to serve the communities in its coverage area. Under subcontract to UTHealth, GHH identified COVID-19 patients into the cohort, queried covered entities for all patient data, aggregated and normalized the data for analysis by clinical specialists and researchers with preapproved proposals and local Institutional Review Board (IRB) approval.