Young Deborah R, Waitzfelder Beth A, Arterburn David, Nichols Gregory A, Ferrara Assiamira, Koebnick Corinna, Yamamoto Ayae, Daley Matthew F, Sherwood Nancy E, Horberg Michael A, Cromwell Lee, Lewis Kristina H
Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States.
JMIR Res Protoc. 2016 Jun 15;5(2):e87. doi: 10.2196/resprot.5589.
The Patient-Centered Outcomes Research Institute (PCORI) created a new national network infrastructure to enable large-scale observational comparative effectiveness research across diverse clinical care settings. As part of testing the feasibility of this effort, each clinical data research network (CDRN) was required to construct cohorts of patients, including one of patients with overweight and obesity.
The aim of this paper is to report on the development of the Patient Outcomes Research to Advance Learning (PORTAL) overweight and obese cohort, which includes patients from 10 health plans located across the United States.
Information was gathered from each plan's electronic health records (EHR). Eligibility included 18 years of age or older, a valid height and weight in 2012 or 2013, and body mass index (BMI) greater than 22.9 kg/m(2). Pre-diabetes and diabetes status was defined using the American Diabetes Association (ADA) criteria, using lab values of glycated hemoglobin (HbA1c) or fasting glucose available in the EHR. Hypertension was identified from the International Classification of Diseases (ICD) diagnosis codes. Individuals were classified into BMI categories: healthy weight (23.0-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), obese class 1 (30.0-34.9 kg/m(2)), obese class 2 (35.0-39.9 kg/m(2)), obese class 3 (40.0-49.0 kg/m(2)), and obese class 4 (>50.0 kg/m(2)).
A cohort of 5,293,458 non-pregnant adults was created. Weight status was 20.39% (1,079,289/5,293,458) healthy weight, 40.40% (2,138,520/5,293,458) overweight, 22.78% (1,205,866/5,293,458) obese class 1, 9.86% (521,872/5,293,458) obese class 2, 5.59% (295,786/5,293,458) obese class 3, and 0.98% (52,125/5,293,458) obese class 4. Race/ethnicity was 49.02% (2,594,776/5,293,458) non-Hispanic white, 22.89% (1,211,677/5,293,458) Hispanic, 10.40% (550,608/5,293,458) Asian, 10.83% (573,506/5,293,458) black, and 6.59% (348,830/5,293,458) other. About 34.33% (1,817,438/5,293,458) met the definition of hypertension, 20.49% (1,660,940/5,293,458) of individuals met the criteria for pre-diabetes, and 14.98% (793,069/5,293,458) met criteria for diabetes. Prevalence of pre-diabetes and diabetes varied across health plans to a greater extent than expected based on hypertension prevalence and BMI status variability.
This large, race, ethnic, and geographically diverse cohort will be useful for future studies of rare exposures or outcomes and differences in health care practices.
以患者为中心的结果研究协会（PCORI）创建了一个新的国家网络基础设施，以支持在不同临床护理环境中开展大规模观察性比较效果研究。作为测试这项工作可行性的一部分，每个临床数据研究网络（CDRN）都被要求构建患者队列，其中包括一个超重和肥胖患者队列。
本文旨在报告推进学习的患者结果研究（PORTAL）超重和肥胖队列的发展情况，该队列包括来自美国各地10个健康计划的患者。
从每个计划的电子健康记录（EHR）中收集信息。纳入标准包括年龄在18岁及以上、2012年或2013年有有效的身高和体重数据，以及体重指数（BMI）大于22.9kg/m²。根据美国糖尿病协会（ADA）标准，利用EHR中糖化血红蛋白（HbA1c）或空腹血糖的实验室值定义糖尿病前期和糖尿病状态。高血压通过国际疾病分类（ICD）诊断代码确定。个体被分为以下BMI类别：健康体重（23.0 - 24.9kg/m²）、超重（25.0 - 29.9kg/m²）、1级肥胖（30.0 - 34.9kg/m²）、2级肥胖（35.0 - 39.9kg/m²）、3级肥胖（40.0 - 49.0kg/m²）和4级肥胖（>50.0kg/m²）。
创建了一个由5,293,458名非妊娠成年人组成的队列。体重状况为：20.39%（1,079,289/5,293,458）为健康体重，40.40%（2,138,520/5,293,458）为超重，22.78%（1,205,866/5,293,458）为1级肥胖，9.86%（521,872/5,293,458）为2级肥胖，5.59%（295,786/5,293,458）为3级肥胖，0.98%（52,125/5,293,458）为4级肥胖。种族/族裔分布为：49.02%（2,594,776/5,293,458）为非西班牙裔白人，22.89%（1,211,677/5,293,458）为西班牙裔，10.40%（550,608/5,293,458）为亚洲人，10.83%（573,506/5,293,458）为黑人，6.59%（348,830/5,293,458）为其他种族。约34.33%（1,817,438/5,293,458）符合高血压定义，20.49%（1,660,940/5,293,458）的个体符合糖尿病前期标准，14.98%（793,069/5,293,458）符合糖尿病标准。糖尿病前期和糖尿病的患病率在不同健康计划中的差异程度大于基于高血压患病率和BMI状态变异性所预期的程度。
这个规模庞大、种族、族裔和地域多样的队列将有助于未来对罕见暴露或结果以及医疗保健实践差异的研究。
