Characterizing chronological accumulation of comorbidities in healthy veterans: a computational approach.
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2021-04-14
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Understanding patient accumulation of comorbidities can facilitate healthcare strategy and personalized preventative care. We applied a directed network graph to electronic health record (EHR) data and characterized comorbidities in a cohort of healthy veterans undergoing screening colonoscopy. The Veterans Affairs Cooperative Studies Program #380 was a prospective longitudinal study of screening and surveillance colonoscopy. We identified initial instances of three-digit ICD-9 diagnoses for participants with at least 5 years of linked EHR history (October 1999 to December 2015). For diagnoses affecting at least 10% of patients, we calculated pairwise chronological relative risk (RR). iGraph was used to produce directed graphs of comorbidities with RR > 1, as well as summary statistics, key diseases, and communities. A directed graph based on 2210 patients visualized longitudinal development of comorbidities. Top hub (preceding) diseases included ischemic heart disease, inflammatory and toxic neuropathy, and diabetes. Top authority (subsequent) diagnoses were acute kidney failure and hypertensive chronic kidney failure. Four communities of correlated comorbidities were identified. Close analysis of top hub and authority diagnoses demonstrated known relationships, correlated sequelae, and novel hypotheses. Directed network graphs portray chronologic comorbidity relationships. We identified relationships between comorbid diagnoses in this aging veteran cohort. This may direct healthcare prioritization and personalized care.
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Hong, Julian C, Elizabeth R Hauser, Thomas S Redding, Kellie J Sims, Ziad F Gellad, Meghan C O'Leary, Terry Hyslop, Ashton N Madison, et al. (2021). Characterizing chronological accumulation of comorbidities in healthy veterans: a computational approach. Scientific reports, 11(1). p. 8104. 10.1038/s41598-021-85546-2 Retrieved from https://hdl.handle.net/10161/23250.
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Ziad F. Gellad
Dr. Gellad is an associate professor of medicine in the Division of Gastroenterology at Duke University Medical Center and the Chief of Gastroenterology at the Durham VA Health Care System. His research focuses on quality of care in gastroenterology, with a particular focus on colorectal cancer screening. Dr. Gellad has also received several innovation grants to develop and implement novel information technology platforms to improve the patient and clinician experience. He is also an active contributor to the innovation and entrepreneurship activities within Duke University and co-founder of a health technology startup in Durham, NC.
Dr. Gellad received his MD and MPH degrees from Johns Hopkins University. He completed a residency in internal medicine and a fellowship in gastroenterology at Duke University Medical Center. Dr. Gellad is past-chair of the Quality Measures Committee of the American Gastroenterological Association, associate editor for GI & Hepatology News and is on the Board of Editors for Clinical Gastroenterology and Hepatology.
Christina D Williams
Brian Sullivan
I am a Physician Scientist in Gastroenterology, with a research focus in optimizing colorectal cancer (CRC) screening and surveillance recommendations, including colonoscopy and other non-invasive screening modalities. Specifically, we are evaluating current and evolving CRC screening strategies, as well as identifying people at high risk for underlying hereditary/genetic CRC syndromes.
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