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Article ; Online: Causes of alcohol-attributable death and associated years of potential life lost among LGB and non-LGB veteran men and women in Veterans Health Administration.

Livingston, Nicholas A / Gatsby, Elise / Shipherd, Jillian C / Lynch, Kristine E

2022 Volume 139, Page(s) 107587

Abstract: Background: Alcohol use is a significant concern nationally and research now highlights higher rates of alcohol attributable death (AAD) and years of potential life lost (YPLL) among lesbian, gay, and bisexual (LGB) veterans compared to non-LGB veterans. ...

Abstract	Background: Alcohol use is a significant concern nationally and research now highlights higher rates of alcohol attributable death (AAD) and years of potential life lost (YPLL) among lesbian, gay, and bisexual (LGB) veterans compared to non-LGB veterans. In this study, we examined specific causes of AAD and associated YPLL between LGB and non-LGB veteran men and women to highlight needed outreach, prevention, and treatment strategies. Methods: Using data from the nationwide Veterans Health Administration electronic health record and National Death Index from 2014 to 2018, we examined the top ten ranked causes of AAD among LGB (n = 102,085) and non-LGB veteran (n = 5,300,521) men and women, as well as associated YPLL per AAD. Results: We observed higher rates of AAD among men than women, but higher rates among LGB veterans relative to their same-sex non-LGB counterparts. We noted greater YPLL per AAD among LGB men and all women compared to non-LGB men, even when of similar or same rank in cause of death. Acute-cause AAD death (e.g., alcohol-related suicide, poisonings) was ranked higher among LGB men and all women. YPLL was greater for both acute- and chronic-cause AAD (e.g., liver disease) among LGB men and all women compared to non-LGB men. Conclusions: Causes of AAD differ between LGB and non-LGB men and women. The differences observed highlight disparities in acute- and chronic-cause AAD between groups help explain the higher number of YPLL per AAD that disfavor LGB men and women veterans, and essential next steps in primary and secondary prevention of hazardous drinking and mortality risk.
MeSH term(s)	Male ; Humans ; Female ; Veterans ; Veterans Health ; Sexual and Gender Minorities ; Bisexuality ; Life Expectancy
Language	English
Publishing date	2022-12-22
Publishing country	England
Document type	Journal Article
ZDB-ID	197618-7
ISSN	1873-6327 ; 0306-4603
ISSN (online)	1873-6327
ISSN	0306-4603
DOI	10.1016/j.addbeh.2022.107587
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Article ; Online: Bridging information gaps in menopause status classification through natural language processing.

Eyre, Hannah / Alba, Patrick R / Gibson, Carolyn J / Gatsby, Elise / Lynch, Kristine E / Patterson, Olga V / DuVall, Scott L

JAMIA open

2024 Volume 7, Issue 1, Page(s) ooae013

Abstract: Objective: To use natural language processing (NLP) of clinical notes to augment existing structured electronic health record (EHR) data for classification of a patient's menopausal status.: Materials and methods: A rule-based NLP system was designed ...

Abstract	Objective: To use natural language processing (NLP) of clinical notes to augment existing structured electronic health record (EHR) data for classification of a patient's menopausal status. Materials and methods: A rule-based NLP system was designed to capture evidence of a patient's menopause status including dates of a patient's last menstrual period, reproductive surgeries, and postmenopause diagnosis as well as their use of birth control and menstrual interruptions. NLP-derived output was used in combination with structured EHR data to classify a patient's menopausal status. NLP processing and patient classification were performed on a cohort of 307 512 female Veterans receiving healthcare at the US Department of Veterans Affairs (VA). Results: NLP was validated at 99.6% precision. Including the NLP-derived data into a menopause phenotype increased the number of patients with data relevant to their menopausal status by 118%. Using structured codes alone, 81 173 (27.0%) are able to be classified as postmenopausal or premenopausal. However, with the inclusion of NLP, this number increased 167 804 (54.6%) patients. The premenopausal category grew by 532.7% with the inclusion of NLP data. Discussion: By employing NLP, it became possible to identify documented data elements that predate VA care, originate outside VA networks, or have no corresponding structured field in the VA EHR that would be otherwise inaccessible for further analysis. Conclusion: NLP can be used to identify concepts relevant to a patient's menopausal status in clinical notes. Adding NLP-derived data to an algorithm classifying a patient's menopausal status significantly increases the number of patients classified using EHR data, ultimately enabling more detailed assessments of the impact of menopause on health outcomes.
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article
ISSN	2574-2531
ISSN (online)	2574-2531
DOI	10.1093/jamiaopen/ooae013
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Article ; Online: Using electronic health records to streamline provider recruitment for implementation science studies.

Okorie, Chiamaka L / Gatsby, Elise / Schroeck, Florian R / Ould Ismail, A Aziz / Lynch, Kristine E

PloS one

2022 Volume 17, Issue 5, Page(s) e0267915

Abstract: Background: Healthcare providers are often targeted as research participants, especially for implementation science studies evaluating provider- or system-level issues. Frequently, provider eligibility is based on both provider and patient factors. ... ...

Abstract	Background: Healthcare providers are often targeted as research participants, especially for implementation science studies evaluating provider- or system-level issues. Frequently, provider eligibility is based on both provider and patient factors. Manual chart review and self-report are common provider screening strategies but require substantial time, effort, and resources. The automated use of electronic health record (EHR) data may streamline provider identification for implementation science research. Here, we describe an approach to provider screening for a Veterans Health Administration (VHA)-funded study focused on implementing risk-aligned surveillance for bladder cancer patients. Methods: Our goal was to identify providers at 6 pre-specified facilities who performed ≥10 surveillance cystoscopy procedures among bladder cancer patients in the 12 months prior to recruitment start on January 16, 2020, and who were currently practicing at 1 of 6 pre-specified facilities. Using VHA EHR data (using CPT, ICD10 procedure, and ICD10 diagnosis codes), we identified cystoscopy procedures performed after an initial bladder cancer diagnosis (i.e., surveillance procedures). Procedures were linked to VHA staff data to determine the provider of record, the number of cystoscopies they performed, and their current location of practice. To validate this approach, we performed a chart review of 105 procedures performed by a random sample of identified providers. The proportion of correctly identified procedures was calculated (Positive Predictive Value (PPV)), along with binomial 95% confidence intervals (CI). Findings: We identified 1,917,856 cystoscopies performed on 703,324 patients from October 1, 1999-January 16, 2020, across the nationwide VHA. Of those procedures, 40% were done on patients who had a prior record of bladder cancer and were completed by 15,065 distinct providers. Of those, 61 performed ≥ 10 procedures and were currently practicing at 1 of the 6 facilities of interest in the 1 year prior to study recruitment. The random chart review of 7 providers found 101 of 105 procedures (PPV: 96%; 95% CI: 91% to 99%) were surveillance procedures and were performed by the selected provider on the recorded date. Implications: These results show that EHR data can be used for accurate identification of healthcare providers as research participants when inclusion criteria consist of both patient- (temporal relationship between diagnosis and procedure) and provider-level (frequency of procedure and location of current practice) factors. As administrative codes and provider identifiers are collected in most, if not all, EHRs for billing purposes this approach can be translated from provider recruitment in VHA to other healthcare systems. Implementation studies should consider this method of screening providers.
MeSH term(s)	Cystoscopy ; Electronic Health Records ; Health Personnel ; Humans ; Implementation Science ; Urinary Bladder Neoplasms/diagnosis
Language	English
Publishing date	2022-05-13
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0267915
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Article: Elevated Risk of Chronic Respiratory Conditions within 60 Days of COVID-19 Hospitalization in Veterans.

Park, Catherine / Razjouyan, Javad / Hanania, Nicola A / Helmer, Drew A / Naik, Aanand D / Lynch, Kristine E / Amos, Christopher I / Sharafkhaneh, Amir

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 2

Abstract: SARS-CoV-2 infection prominently affects the respiratory system, and patients hospitalized with COVID-19 are at an increased risk of developing respiratory conditions. We examined the risk of new respiratory conditions of COVID-19 among hospitalized ... ...

Abstract	SARS-CoV-2 infection prominently affects the respiratory system, and patients hospitalized with COVID-19 are at an increased risk of developing respiratory conditions. We examined the risk of new respiratory conditions of COVID-19 among hospitalized patients in the national Veterans Health Administration between 15 February 2020 and 16 June 2021. The study cohort included all COVID-19-tested, hospitalized individuals who survived the index admission and did not have any previously diagnosed chronic respiratory conditions (asthma, bronchitis, chronic lung disease, chronic obstructive pulmonary disease (COPD), emphysema, or venous thromboembolism) before SARS-CoV-2 testing. Of 373,048 patients hospitalized after SARS-CoV-2 testing, 18,686 positive and 37,372 negative patients met the inclusion/exclusion criteria and were matched by age, sex, and race using propensity score matching. The results showed that the SARS-CoV-2 positive group had a greater risk of developing asthma (adjusted odds ratio (aOR) = 1.37), bronchitis (aOR = 2.81), chronic lung disease (aOR = 2.14), COPD (aOR = 1.56), emphysema (aOR = 1.52), and venous thromboembolism (aOR = 1.92) within 60 days after the index COVID date of testing. These findings could inform that the clinical care team considers a risk of new respiratory conditions and address these conditions in the post-hospitalization management of the patient, which could potentially lead to reduce the risk of complications and optimize recovery.
Language	English
Publishing date	2022-02-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10020300
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Article: Sleep disturbance and suicide risk among sexual and gender minority people.

Dolsen, Emily A / Byers, Amy L / Flentje, Annesa / Goulet, Joseph L / Jasuja, Guneet K / Lynch, Kristine E / Maguen, Shira / Neylan, Thomas C

Neurobiology of stress

2022 Volume 21, Page(s) 100488

Abstract: Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender ...

Abstract	Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.
Language	English
Publishing date	2022-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2816500-7
ISSN	2352-2895
ISSN	2352-2895
DOI	10.1016/j.ynstr.2022.100488
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Article: Assessing Smoking Status and Risk of SARS-CoV-2 Infection: A Machine Learning Approach among Veterans.

Nono Djotsa, Alice B S / Helmer, Drew A / Park, Catherine / Lynch, Kristine E / Sharafkhaneh, Amir / Naik, Aanand D / Razjouyan, Javad / Amos, Christopher I

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 7

Abstract: The role of smoking in the risk of SARS-CoV-2 infection is unclear. We used a retrospective cohort design to study data from veterans' Electronic Medical Record to assess the impact of smoking on the risk of SARS-CoV-2 infection. Veterans tested for the ... ...

Abstract	The role of smoking in the risk of SARS-CoV-2 infection is unclear. We used a retrospective cohort design to study data from veterans' Electronic Medical Record to assess the impact of smoking on the risk of SARS-CoV-2 infection. Veterans tested for the SARS-CoV-2 virus from 02/01/2020 to 02/28/2021 were classified as: Never Smokers (NS), Former Smokers (FS), and Current Smokers (CS). We report the adjusted odds ratios (aOR) for potential confounders obtained from a cascade machine learning algorithm. We found a 19.6% positivity rate among 1,176,306 veterans tested for SARS-CoV-2 infection. The positivity proportion among NS (22.0%) was higher compared with FS (19.2%) and CS (11.5%). The adjusted odds of testing positive for CS (aOR:0.51; 95%CI: 0.50, 0.52) and FS (aOR:0.89; 95%CI:0.88, 0.90) were significantly lower compared with NS. Four pre-existing conditions, including dementia, lower respiratory infections, pneumonia, and septic shock, were associated with a higher risk of testing positive, whereas the use of the decongestant drug phenylephrine or having a history of cancer were associated with a lower risk. CS and FS compared with NS had lower risks of testing positive for SARS-CoV-2. These findings highlight our evolving understanding of the role of smoking status on the risk of SARS-CoV-2 infection.
Language	English
Publishing date	2022-07-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10071244
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Article ; Online: Overall and sex-specific risk factors for subjective cognitive decline: findings from the 2015-2018 Behavioral Risk Factor Surveillance System Survey.

Schliep, Karen C / Barbeau, William A / Lynch, Kristine E / Sorweid, Michelle K / Varner, Michael W / Foster, Norman L / Qeadan, Fares

Biology of sex differences

2022 Volume 13, Issue 1, Page(s) 16

Abstract: Background: Prior research indicates that at least 35% of Alzheimer's disease and related dementia risk may be amenable to prevention. Subjective cognitive decline is often the first indication of preclinical dementia, with the risk of subsequent ... ...

Abstract	Background: Prior research indicates that at least 35% of Alzheimer's disease and related dementia risk may be amenable to prevention. Subjective cognitive decline is often the first indication of preclinical dementia, with the risk of subsequent Alzheimer's disease in such individuals being greater in women than men. We wished to understand how modifiable factors are associated with subjective cognitive decline, and whether differences exist by sex. Methods: Data were collected from men and women (45 years and older) who completed the U.S. Behavioral Risk Factor Surveillance System Cognitive Decline Module (2015-2018), n = 216,838. We calculated population-attributable fractions for subjective cognitive decline, stratified by sex, of the following factors: limited education, deafness, social isolation, depression, smoking, physical inactivity, obesity, hypertension, and diabetes. Our models were adjusted for age, race, income, employment, marital and Veteran status, and accounted for communality among risk factors. Results: The final study sample included more women (53.7%) than men, but both had a similar prevalence of subjective cognitive decline (10.6% of women versus 11.2% of men). Women and men had nearly equivalent overall population-attributable fractions to explain subjective cognitive decline (39.7% for women versus 41.3% for men). The top three contributing risk factors were social isolation, depression, and hypertension, which explained three-quarters of the overall population-attributable fraction. Conclusions: While we did not identify any differences in modifiable factors between men and women contributing to subjective cognitive decline, other factors including reproductive or endocrinological health history or biological factors that interact with sex to modify risk warrant further research.
MeSH term(s)	Alzheimer Disease ; Behavioral Risk Factor Surveillance System ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/psychology ; Female ; Humans ; Hypertension/epidemiology ; Male ; Risk Factors
Language	English
Publishing date	2022-04-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2587352-0
ISSN	2042-6410 ; 2042-6410
ISSN (online)	2042-6410
ISSN	2042-6410
DOI	10.1186/s13293-022-00425-3
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Article ; Online: Sexual Health Assessment Is Vital to Whole Health Models of Care.

Uzdavines, Alex / Helmer, Drew A / Spelman, Juliette F / Mattocks, Kristin M / Johnson, Amanda M / Chardos, John F / Lynch, Kristine E / Kauth, Michael R

JMIRx med

2022 Volume 3, Issue 3, Page(s) e36266

Abstract: Sexual health is the state of well-being regarding sexuality. Sexual health is highly valued and associated with overall health. Overall health and well-being are more than the absence of disease or dysfunction. Health care systems adopting whole health ... ...

Abstract	Sexual health is the state of well-being regarding sexuality. Sexual health is highly valued and associated with overall health. Overall health and well-being are more than the absence of disease or dysfunction. Health care systems adopting whole health models of care need to incorporate a holistic assessment of sexual health. This includes assessing patients' sexual orientation and gender identity (SOGI). If health systems, including but not limited to the Veterans Health Administration (VHA), incorporate sexual health into whole health they could enhance preventive care, promote healthy sexual functioning, and optimize overall health and well-being. Assessing sexual health can give providers important information about a patient's health, well-being, and health goals. Sexual concerns or dysfunction may also signal undiagnosed health conditions. Additionally, collecting SOGI information as part of a sexual health assessment would allow providers to address problems that drive disparities for lesbian, gay, bisexual, transgender, queer, and similar minority (LGBTQ+) populations. Health care providers do not routinely assess sexual health in clinical practice. One barrier is a gap in communication between patients and providers. Providers cite beliefs that patients will bring up sexual concerns themselves or might be offended by discussing sexual health. Patients often report an expectation that providers will bring up sexual health and being comfortable discussing sexual health with their providers. Within the VHA, the lack of a sexual health template within the electronic health record (EHR) adds an additional barrier. The VHA's transition toward whole health and updates to its EHR provide unique opportunities to integrate sexual health assessment into routine care. We highlight system modifications to address this within the VHA. These examples may be helpful for other health care systems interested in moving toward whole health. It will be vital for health care systems integrating a whole health approach to develop both practical and educational interventions to address the communication gap. These interventions will need to target both providers and patients in health care systems that transition to a whole health model of care, not just the VHA. Both the communication gap between providers and patients, and the lack of support within some EHR systems for sexual health assessment are barriers to assessing sexual health in primary care clinics. Routine sexual health assessment would benefit patient well-being and present an opportunity to address health disparities for LGBTQ+ populations. Health care systems (ie, both the VHA and other systems) can overcome these barriers by implementing educational interventions and updating their EHRs and back-end data structures. VHA's expertise in developing and implementing health education interventions and EHR-based quality improvements may help inform interventions beyond VHA.
Language	English
Publishing date	2022-07-28
Publishing country	Canada
Document type	Journal Article
ISSN	2563-6316
ISSN (online)	2563-6316
DOI	10.2196/36266
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Article ; Online: Identifying Posttraumatic Stress Disorder and Disparity Among Transgender Veterans Using Nationwide Veterans Health Administration Electronic Health Record Data.

Livingston, Nicholas A / Lynch, Kristine E / Hinds, Zig / Gatsby, Elise / DuVall, Scott L / Shipherd, Jillian C

LGBT health

2022 Volume 9, Issue 2, Page(s) 94–102

Abstract: Purpose: ...

Abstract	Purpose:
MeSH term(s)	Electronic Health Records ; Humans ; Infant, Newborn ; Stress Disorders, Post-Traumatic/epidemiology ; Stress Disorders, Post-Traumatic/psychology ; Transgender Persons/psychology ; United States/epidemiology ; United States Department of Veterans Affairs ; Veterans/psychology ; Veterans Health
Language	English
Publishing date	2022-01-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2727303-9
ISSN	2325-8306 ; 2325-8292
ISSN (online)	2325-8306
ISSN	2325-8292
DOI	10.1089/lgbt.2021.0246
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Article ; Online: Alcohol-attributable deaths and years of potential life lost due to alcohol among veterans: Overall and between persons with minoritized and non-minoritized sexual orientations.

Lynch, Kristine E / Livingston, Nicholas A / Gatsby, Elise / Shipherd, Jillian C / DuVall, Scott L / Williams, Emily C

Drug and alcohol dependence

2022 Volume 237, Page(s) 109534

Abstract: Background: Unhealthy alcohol use is disproportionally experienced by individuals with minoritized sexual orientations. Unlike the general US population, for whom the burden of alcohol as it relates to mortality is consistently monitored across time ... ...

Abstract	Background: Unhealthy alcohol use is disproportionally experienced by individuals with minoritized sexual orientations. Unlike the general US population, for whom the burden of alcohol as it relates to mortality is consistently monitored across time with national survey data, the impact of unhealthy alcohol use among veterans with minoritized sexual orientations, for whom addressing substance use is a national priority, is largely unknown. Methods: Using Alcohol Use Disorders Identification Test Consumption data from the Department of Veterans Affairs electronic health record and underlying cause of death from National Death Index from 2014 to 2018 we quantified alcohol consumption and related mortality among veterans with (n = 102,085) and without minoritized sexual orientations (n = 5300,521). Age adjusted rates of alcohol attributed deaths (AAD) per 100,000 persons and years of potential life lost (YPLL) were estimated by sexual orientation, sex, and sexual orientation stratified by sex. Results: Alcohol attributable deaths (n = 21,861) were higher among veterans with minoritized sexual orientations than veterans without after adjustment for age (486.5 deaths/100,000 versus 309.7 deaths/100,000, respectively). Veterans with minoritized sexual orientations also experienced more YPLL (13,772.8 years/100,000 versus 7618.9 years/100,000). Years of potential life lost per AAD was higher in women (33.2 years) than men (18.7 years). Conclusions: Alcohol consumption results in substantial disability and death among veterans, particularly veterans with minoritized sexual orientations. Findings suggest need for increased alcohol-related services for all VA patients, and potential targeted approaches to for veterans with minoritized sexual orientations and women to offset risk for, and years of potential life lost from, alcohol attributable death.
MeSH term(s)	Alcohol Drinking ; Alcoholism ; Female ; Humans ; Life Expectancy ; Male ; Sexual Behavior ; Veterans
Language	English
Publishing date	2022-06-10
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2022.109534
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