Racially and ethnically diverse minorities often experience the disease burden of sexually transmitted infections or diseases (STD) more often than their White counterparts. Yet, little is known about the connection of STD systematic discrimination, racism, and social and behavioral determinants. Plus, little to no details exists related to how this information is recorded in their Electronic Health Records (EHRs). The objective of this study is to assess the completeness of social and behavioral determinants of health (SDOH) data in the EHRs of a minority cohort with STD.
Materials and Methods
2,993 minority patients diagnosed with a STD at the Mayo Clinic were identified for this study. A natural language processing (NLP) algorithm was applied on the Patient-Provided Information (PPI) in their EHRs to extract SDOH information in six domains that are associated with STD, namely alcohol use, substance use, sexual activity, sexual orientation, housing status, and employment status. The completeness of SDOH was assessed in terms of documentation, breadth, and density.
Our study indicates that nearly half of 2,993 patients did not have SDOH-related PPI records in their EHRs whereas the patients who had SDOH-related PPI records had well-documented records for five out of six SDOH domains, including alcohol use, substance use, sexual activity, housing status, and employment status, except for sexual orientation. A total of 1,504 patients had PPI in their EHRs for at least one of six SDOH domains, which is about 50.3% of the study cohort. Most SDOH domains have a short time span of 1 year, with up to 18 years of record data. Our analysis also indicated that education and age have a significant impact on the recording of SDOH-related PPI records. Patients that are female, older, and higher educated tend to have more SDOH information available in their records.
Discussion and Conclusion
We assessed the completeness of SDOH information recorded in the PPI from patients’ EHRs. Due to large amounts of missing SDOH information in the PPI, future research is needed to integrate accurate and robust SDOH related data for downstream research and the impact of systematic discrimination on how this information is collected and interpreted in the EHRs.