Mining 100 million notes to find homelessness and adverse childhood experiences: 2 case studies of rare and severe social determinants of health in electronic health records

• Published in: Journal of the American Medical Informatics Association : JAMIA Vol. 25; no. 1; pp. 61 - 71
• Main Authors: Bejan, Cosmin A, Angiolillo, John, Conway, Douglas, Nash, Robertson, Shirey-Rice, Jana K, Lipworth, Loren, Cronin, Robert M, Pulley, Jill, Kripalani, Sunil, Barkin, Shari, Johnson, Kevin B, Denny, Joshua C
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2018
• Subjects: Research and Applications; social determinants of health; text mining; homelessness; EHR; adverse childhood experiences
• ISSN: 1067-5027; 1527-974X
• DOI: 10.1093/jamia/ocx059

Abstract Objective Understanding how to identify the social determinants of health from electronic health records (EHRs) could provide important insights to understand health or disease outcomes. We developed a methodology to capture 2 rare and severe social determinants of health, homelessness and adverse childhood experiences (ACEs), from a large EHR repository. Materials and Methods We first constructed lexicons to capture homelessness and ACE phenotypic profiles. We employed word2vec and lexical associations to mine homelessness-related words. Next, using relevance feedback, we refined the 2 profiles with iterative searches over 100 million notes from the Vanderbilt EHR. Seven assessors manually reviewed the top-ranked results of 2544 patient visits relevant for homelessness and 1000 patients relevant for ACE. Results word2vec yielded better performance (area under the precision-recall curve [AUPRC] of 0.94) than lexical associations (AUPRC = 0.83) for extracting homelessness-related words. A comparative study of searches for the 2 phenotypes revealed a higher performance achieved for homelessness (AUPRC = 0.95) than ACE (AUPRC = 0.79). A temporal analysis of the homeless population showed that the majority experienced chronic homelessness. Most ACE patients suffered sexual (70%) and/or physical (50.6%) abuse, with the top-ranked abuser keywords being “father” (21.8%) and “mother” (15.4%). Top prevalent associated conditions for homeless patients were lack of housing (62.8%) and tobacco use disorder (61.5%), while for ACE patients it was mental disorders (36.6%–47.6%). Conclusion We provide an efficient solution for mining homelessness and ACE information from EHRs, which can facilitate large clinical and genetic studies of these social determinants of health.