Predicting Life Expectancy to Target Cancer Screening Using Electronic Health Record Clinical Data.

Lee AK, Jing B, Jeon SY, Boscardin WJ, Lee SJ. Predicting Life Expectancy to Target Cancer Screening Using Electronic Health Record Clinical Data. Journal of general internal medicine. 2022 Feb 1; 37(3):499-506.

Related HSR&D Project(s)

• IIR 15-434 – Development and Validation of 10-Year Life Expectancy Calculators to Individualize Veterans’ Prevention Decisions

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Abstract:

BACKGROUND: Guidelines recommend breast and colorectal cancer screening for older adults with a life expectancy > 10 years. Most mortality indexes require clinician data entry, presenting a barrier for routine use in care. Electronic health records (EHR) are a rich clinical data source that could be used to create individualized life expectancy predictions to identify patients for cancer screening without data entry. OBJECTIVE: To develop and internally validate a life expectancy calculator from structured EHR data. DESIGN: Retrospective cohort study using national Veteran''s Affairs (VA) EHR databases. PATIENTS: Veterans aged 50+ with a primary care visit during 2005. MAIN MEASURES: We assessed demographics, diseases, medications, laboratory results, healthcare utilization, and vital signs 1 year prior to the index visit. Mortality follow-up was complete through 2017. Using the development cohort (80% sample), we used LASSO Cox regression to select ~100 predictors from 913 EHR data elements. In the validation cohort (remaining 20% sample), we calculated the integrated area under the curve (iAUC) and evaluated calibration. KEY RESULTS: In 3,705,122 patients, the mean age was 68 years and the majority were male (97%) and white (85%); nearly half (49%) died. The life expectancy calculator included 93 predictors; age and gender most strongly contributed to discrimination; diseases also contributed significantly while vital signs were negligible. The iAUC was 0.816 (95% confidence interval, 0.815, 0.817) with good calibration. CONCLUSIONS: We developed a life expectancy calculator using VA EHR data with excellent discrimination and calibration. Automated life expectancy prediction using EHR data may improve guideline-concordant breast and colorectal cancer screening by identifying patients with a life expectancy > 10 years.