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Medical data yield hidden abuse diagnoses

October 5, 2009

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Boston researchers have developed a novel use for electronic medical records: By analyzing data in patient records, they say they were able to identify likely victims of domestic abuse an average of two years before a diagnosis was actually made.

Ben Reis and his colleagues from Children’s Hospital Boston studied six years of hospital admissions and emergency visits for patients over 18 years old. Based on a patient’s medical history, including injuries and assaults, they determined whether the person met a definition of domestic abuse. Then they looked at actual diagnoses.

“Our model predicted abuse two years before it appeared on medical records,’’ Reis said.

The risk factors linked to a future domestic abuse diagnosis differed between men and women. For women, the red flags were trips to the hospital to treat injuries, poisoning, and alcoholism. For men, depression and psychosis were associated with the greatest risk.

The researchers say the model is not ready to be implemented, but it could form the basis for an early warning system that would help doctors decide which patients need further screening and, perhaps, intervention.

BOTTOM LINE: Using information in patients’ electronic medical records, researchers identified domestic abuse two years before that diagnosis was made.

CAUTIONS: The screening tool needs to be refined before it could be used in hospitals.

WHAT’S NEXT: The researchers are studying the use of electronic medical records to forecast other health problems, from diabetes to depression, that might lead to what they call “predictive medicine.’’

WHERE TO FIND IT: British Medical Journal, Sept. 29

Middle-age weight gain hurts health after 70

Americans are both living longer and growing heavier. New research explores how weight gain might affect quality of life in old age.

Researchers led by Qi Sun of the Harvard School of Public Health looked at body weight and both physical and mental health among more than 17,000 women 70 or older who took part in the long-running Nurses Health Study. The women have answered questionnaires about their health and habits every two years since the study began, when their average age was 50. They also were asked to recall their weight at age 18 and participated in telephone interviews to assess their cognitive status and emotional well-being.

Based on their answers, the women were classified as healthy survivors if they had reached age 70 without chronic medical conditions, such as diabetes or heart disease, or limitations on their daily activities, such as climbing stairs.

After accounting for factors such as cigarette smoking or family history of disease, the women who were obese when they were middle-aged were 79 percent less likely to be healthy survivors at age 70 than women whose body mass index was normal. For every additional BMI unit beyond normal, the odds of healthy survival fell by 12 percent. For every kilogram - a little over 2 pounds - gained since age 18, the odds of healthy survival fell by 5 percent.

BOTTOM LINE: Women who were obese in their middle years were less likely to be healthy past age 70 than women who were lean in midlife.

CAUTIONS: The study subjects were women, most of them white, so its findings might not apply to men and other groups of women. Also, the study relied on the women’s recollections of their weight at age 18, not medical records.

WHERE TO FIND IT: British Medical Journal, Sept. 29


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