Identifying monoclonal gammopathy of undetermined significance from electronic health records

BACKGROUND

Monoclonal gammopathy of undetermined significance (MGUS) precedes multiple myeloma (MM). Use of electronic health records may facilitate large-scale epidemiologic research to elucidate risk factors for the progression of MGUS to MM or other lymphoid malignancies.

AIMS

We evaluated the accuracy of an electronic health records-based approach for identifying clinically diagnosed MGUS cases for inclusion in studies of patient outcomes/ progression risk.

METHODS AND RESULTS

Data were retrieved from Kaiser Permanente Southern California's comprehensive electronic health records, which contain documentation of all outpatient and inpatient visits, laboratory tests, diagnosis codes and a cancer registry. We ascertained potential MGUS cases diagnosed between 2008 and 2014 using the presence of an MGUS ICD-9 diagnosis code (273.1). We initially excluded those diagnosed with MM within 6 months after MGUS diagnosis, then subsequently those with any lymphoid malignancy diagnosis from 2007 to 2014. We reviewed medical charts for 100 randomly selected potential cases for evidence of a physician diagnosis of MGUS, which served as our gold standard for case confirmation. To assess sensitivity, we also investigated the presence of the ICD-9 code in the records of 40 randomly selected and chart review-confirmed MGUS cases among patients with a laboratory report of elevated circulating monoclonal (M-) protein (a key test for MGUS diagnosis) and no subsequent lymphoid malignancy (as described above). The positive predictive value (PPV) for the ICD-9 code was 98%. All MGUS cases confirmed by chart review also had confirmatory laboratory test results. Of the confirmed cases first identified via M-protein test results, 88% also had the ICD-9 diagnosis code.

CONCLUSION

The diagnosis code-based approach has excellent PPV and likely high sensitivity for detecting clinically diagnosed MGUS. The generalizability of this approach outside an integrated healthcare system warrants further evaluation.

Trends in Influenza Vaccine Uptake and Severe Influenza-Related Outcomes at Kaiser Permanente Southern California, 2007-2017

INTRODUCTION

Major efforts to increase influenza vaccine uptake among Kaiser Permanente Southern California (KPSC) members have been undertaken in recent years. However, whether these improvements translate to a decline in severe influenza-related outcomes has not been examined. We aimed to understand the impact of the influenza vaccination program at KPSC by examining influenza vaccine uptake and 3 severe influenza-related outcomes.

METHODS

We conducted an ecologic trend analysis to understand influenza vaccine uptake and influenza-related hospitalization, intensive care unit (ICU) admission, and mortality for each influenza season (2007-2017). The same cohort was followed from the influenza season to the noninfluenza season immediately afterward while using the noninfluenza season as the comparison group. We also assessed the within-season correlation between influenza vaccine uptake and influenza-related outcomes.

RESULTS

Influenza vaccine uptake rose from 23.9% to 45.5%, and all 3 influenza-related outcome rates declined (hospitalization: 35.4-26.8/10,000 patients; ICU: 5.9-5.2/10,000 patients; and mortality: 3.4-2.3/10,000 patients). Influenza vaccine uptake was negatively correlated with hospitalization (-0.32, p < 0.001) and mortality (-0.29, p = 0.001). However, once we adjusted for the noninfluenza season, the results of the correlation analysis were no longer statistically significant.

CONCLUSION

Although we could not establish a statistically significant inverse relationship between influenza vaccination and severe influenza-related outcomes over the study period, our findings indicate an overall decline in influenza-related outcomes over the study period, suggesting improvements in both preventive and acute care quality at KPSC.

Adherence to cardiomyopathy screening guidelines among adolescent and young adult cancer survivors exposed to chest radiation and/or anthracyclines

PURPOSE

Cancer survivors are at risk for late effects from therapeutic exposures, including cardiovascular complications. To improve outcomes among adolescents and young adults (AYA) with cancer, the National Comprehensive Cancer Network (NCCN) released guidelines for screening services (based on the Children's Oncology Group Long-Term Follow-Up [LTFU] guidelines) for survivors of AYA cancer. To better understand survivorship care gaps, we conducted a baseline evaluation of cardiomyopathy screening among survivors of AYA cancers.

METHODS

Members of Kaiser Permanente Southern California diagnosed with cancer between ages 15 and 39 from 2000 to 2010 with at least 5-year survival after diagnosis who were exposed to chest radiation and/or anthracyclines were included. We calculated the Prevention Index ([PI], proportion of person-time covered by receipt of preventive services relative to the total person-time eligible) to evaluate adherence to recommended cardiomyopathy screenings based on the LTFU through 2016. Predictors for screening were evaluated in multivariable logistic regression.

RESULTS

Among 479 survivors recommended for cardiomyopathy screening, 28 received at least one screening, and the mean PI was 2.38% (SD = 13.05%, median = 0.00%). Compared to stage I, survivors of stage II (odds ratio [OR] = 5.56 [1.05-29.46]) and stage III/IV cancer (OR = 6.08 [1.10-33.54]) were more likely to receive cardiomyopathy screening.

CONCLUSIONS

Cardiomyopathy screening among survivors was low around the time when NCCN AYA oncology guidelines were released.

IMPLICATIONS FOR CANCER SURVIVORS

Our study highlights significant room for improvement for adherence to cardiomyopathy screening recommendations among survivors of AYA cancer. Attention is needed to ensure that recommended cardiomyopathy screenings are met for better management of cardiomyopathy late effects.

Abstract 5752: Identifying monoclonal gammopathy of undetermined significance from electronic health records in a large, integrated healthcare network

Monoclonal gammopathy of undetermined significance (MGUS) is an obligate precursor to multiple myeloma (MM) and occurs among approximately 3% of US adults age ≥50 years. Use of data programmatically retrieved from electronic health records (EHR) may facilitate research to better understand risk factors for MGUS and the progression to MM. The aim of this study was to evaluate the accuracy of two EHR-based approaches for identifying MGUS cases. The study population included members of Kaiser Permanente Southern California (KPSC), an integrated healthcare network with more than 4.6 million members. Data were retrieved from KPSC's Surveillance, Epidemiology and End Results (SEER)-affiliated cancer registry as well as from comprehensive EHR, which contain chart notes from medical encounters, lab data, and diagnosis codes. Using KPSC's EHR, we identified potential MGUS cases programmatically using two approaches: serum monoclonal (M)-protein lab values and ICD-9 codes. For both approaches, ≥1 year of KPSC membership prior to the date of the qualifying lab test or diagnosis (“index date”) was required. We excluded members with a diagnosis of MM within 6 months after the index date using cancer registry data. For the M-protein approach, we included cases who met the following criteria: 1) a first recorded serum M-protein (identified using CPT code 84165) occurring after 2008 (when M-protein data became fully accessible electronically) and 2) an M-protein lab value of 0-3 g/dL from 2008-2014. For the ICD approach, we included cases with a first recorded ICD-9 diagnosis code for MGUS (273.1) from 2008-2014. For each approach, we randomly selected 100 cases to be confirmed via manual chart review of documentation +/- 6 months from the index date. A physician diagnosis of MGUS in the chart notes was considered the gold standard for confirmation. Positive predictive values (PPV) were calculated. The manual chart review for the M-protein approach indicated a low PPV (61.2%), and reviews were halted after 67 cases. To improve the accuracy, we expanded our exclusion criteria to any hematopoietic/lymphoid malignancy from 2007-2014. Among the remaining 54 chart-reviewed cases, 40 (74.1%) were confirmed as incident or prevalent MGUS cases, and 14 (25.9%) were classified as “other.” From the cases identified with ICD-9 codes, 92 remained after we applied the expanded exclusion criteria. Among those, 90 (97.8%) were confirmed with chart notes and 2 (2.2%) were not confirmed. We established an algorithmic approach to efficiently and accurately identify MGUS cases for population-based research. Our findings suggest that the ICD code approach has excellent PPV. The poor performance of the M-protein approach appears to be due both to a lack of physician documentation and the use of M-protein to monitor patients previously diagnosed with lymphoproliferative disorders. Further investigation is warranted to evaluate the generalizability of the ICD approach outside KPSC.

Citation Format: Hilary C. Tanenbaum, Brenda Birmann, Kimberly Bertrand, Lauren Teras, Amrita Krishnan, Sophia Wang, Chun Chao. Identifying monoclonal gammopathy of undetermined significance from electronic health records in a large, integrated healthcare network [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5752.

Differences in Estimates of Post-Herpetic Neuralgia Between Medical Chart Review and Self-Report

PURPOSE

Post-herpetic neuralgia (PHN) is a common herpes zoster (HZ) complication, where pain persists 90 days after the initial HZ diagnosis. Evaluating PHN risk is essential for determining the burden on patients and health-care systems, but research shows variable estimates. The extent to which these differences are related to the assessment method has not been examined. The purpose of this study is to compare the proportion of PHN among HZ patients measured by medical chart review and self-report surveys.

METHODS

PHN risk was assessed among a sample of Kaiser Permanente Southern California members with HZ. Chart reviews identified lingering pain 90-180 days post-HZ diagnosis and the Zoster Brief Pain Inventory was administered 90 days post-HZ diagnosis by telephone. Frequencies of PHN identified with each approach were cross-tabulated and stratified by sex, age group, and zoster vaccine live vaccination status.

RESULTS

Chart review and self-report were largely concordant (n=875, 89.20%); however, chart review yielded lower PHN risk overall and for the stratified subgroups. PHN from self-report was substantially higher (6.30-8.33%) among patients who were male, ≥70 years, or unvaccinated. Among those who typically seek care more often (female, younger, vaccinated), the discrepancy between each method was notably lower (1.60-2.92%).

CONCLUSION

Our findings suggest that chart review underestimates cases among those less likely to seek health care, including males, the elderly, and unvaccinated individuals. The agreement between the methods indicates that each can provide a reasonable approximation of PHN, but analyses should carefully control for health-care utilization.

Associations between psychological characteristics and indicators of metabolic syndrome among Chinese adults

Current knowledge about the relationship between psychological characteristics and metabolic syndrome (MetS) components is limited in Asian populations. The purpose of this study is to investigate linkages between physiological markers of MetS and life satisfaction, hostility, and depression in Chinese adults. Secondary analyses were conducted using cross-sectional data from parents of randomly selected middle school students participating in a pilot study in Qingdao, China. Among 440 parents who consented to participate (237 women, 203 men), 368 provided valid responses in all three categories of psychological characteristics, and only those subjects were included in these analyses. General linear models and logistic regressions were run separately by gender, controlling for covariates. Among women, life satisfaction was inversely associated with triglyceride levels (p = .04), LDL-C (p < .01), risk of hypertriglyceridemia (OR[.53], p < .01), HDL-C (OR[.78], p = .03), and MetS (OR[.52], p = .03). No associations were found between life satisfaction and any psychological characteristics among men. Among women, hostility was positively associated with triglyceride level (p = .04) and risk of hypertriglyceridemia (OR[2.12], p < .05). Among men, hostility was positively associated with waist circumference (p = .04), waist-hip ratio (p < .05), and fasting plasma insulin (p < .01). Depression was not associated with any physiological measurement in either gender. These findings indicate that relationships exist between certain psychological characteristics and physiological indicators of MetS among Chinese adults, although there may be important differences between genders.

Overweight Perception: Associations with Weight Control Goals, Attempts, and Practices among Chinese Female College Students

BACKGROUND

Concurrent with the dramatic cultural and economic shifts occurring as mainland China becomes increasingly "Westernized," the weight perceptions, ideal body weight, and weight management goals and practices of Chinese females have also undergone significant changes.

OBJECTIVE

To investigate relationships between overweight status, weight perception patterns, and weight management goals and practices in Chinese female college students.

DESIGN/PARTICIPANTS/SETTING

A cross-sectional analysis was conducted with data from 902 female subjects aged 18 to 25 years participating in the China Seven Cities Study, a health promotion and smoking prevention study conducted in mainland China in 2003.

MAIN OUTCOME MEASURES/STATISTICAL ANALYSES

Logistic regression models were used to explore associations between overweight status, weight perception, specific weight management goals and practices, and current levels of vigorous-intensity physical activity and food consumption.

RESULTS

Based on World Health Organization standards for Asian adults, 16.7% of college females were overweight or obese, although 50.8% considered themselves to be "too heavy." Among participants perceiving themselves as overweight (n=458), 69.2% (n=371) were inaccurate and did not meet criteria for overweight or obese. The percentage of participants attempting weight loss was 48.2%, and 33.1% wanted to maintain their current weight. Attempts to lose or maintain weight were related to actual and perceived weight status, but not to increased vigorous-intensity physical activity or fruit and vegetable intake, nor to decreased consumption of sweets, soda, Western fast foods, and fried foods. Only 21.5% of participants desiring weight loss or maintenance reported using a combination of vigorous-intensity physical activity and a reduced-fat and -calorie diet, whereas 20.2% tried extreme methods such as fasting, using diet pills, vomiting, or smoking.

CONCLUSIONS

Our findings underscore the need to promote healthy weight management practices among Chinese female college students, with an emphasis on diet and physical activity strategies that encourage balance rather than extremes.

A longitudinal analysis of the effects of socioeconomic factors, foreign media, and attitude toward appearance on general and central adiposity in Chinese adolescents

This paper explores the longitudinal effects of socioeconomic factors (i.e., parent education and family income level), foreign media, and attitude toward appearance on general and central adiposity among Chinese adolescents.

A longitudinal analysis was performed using data from the China Seven Cities Study, a health promotion and smoking prevention study conducted in seven cities across Mainland China between 2002 and 2005. Participants included 5,020 middle and high school students and their parents. Explanatory variables included foreign media exposure, attitude toward appearance, parent education, and family income. Three-level, random-effect models were used to predict general adiposity (i.e., body mass index) and central adiposity (i.e., waist circumference). The Generalized Estimating Equation approach was utilized to determine the effect of explanatory variables on overweight status.

Among girls, foreign media exposure was significantly negatively associated with general adiposity over time (β = − 0.06, p = 0.01 for middle school girls; β = − 0.06, p = 0.03 for high school girls). Attitude toward appearance was associated with lesser odds of being overweight, particularly among high school girls (OR = 0.86, p < 0.01). Among boys, parental education was significantly positively associated with general adiposity (β = 0.62, p < 0.01 for middle school boys; β = 0.37, p = 0.02 for high school boys) and associated with greater odds of being overweight (OR = 1.55, p < 0.01 for middle school boys; OR = 1.26, p = 0.04 for high school boys). Across all gender and grade levels, family income was significantly negatively associated with central adiposity over time.

Interventions addressing Chinese adolescent overweight/obesity should consider these factors as potential focus areas.

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Foreign media exposure decreases BMI over time among girls.

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Girls placing importance on appearance have lesser odds of being overweight.

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Boys have greater odds of being overweight with high parent education.

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High family income was negatively associated with central adiposity.