Multi-site Analysis of COVID-19 and New-onset Diabetes Reveals Need For Improved Sensitivity of EHR-based COVID-19 Phenotypes-a DiCAYA Network Analysis.

Details

• Alternative Title:
  Journal of the American Medical Informatics Association: JAMIA, 2025, v. 33, no. 3: Multi-site Analysis of COVID-19 and New-onset Diabetes Reveals Need For Improved Sensitivity of EHR-based COVID-19 Phenotypes-a DiCAYA Network Analysis.
• Journal Article:
  Journal of the American Medical Informatics Association: JAMIA
• Personal Author:
  Conderino, Sarah ; Kirchner, H. Lester ; Thorpe, Lorna E. ; Divers, Jasmin ; Hirsch, Annemarie G. ; Nordberg, Cara M. ; Schwartz, Brian S. ; Zhang, Lu ; Cai, Bo ; Rudisill, Caroline ; Obeid, Jihad S. ; Liese, Angela ; Allen, Katie S. ; Dixon, Brian E. ; Crume, Tessa ; Dabelea, Dana ; Burgett, Shawna ; Bellatorre, Anna ; Shao, Hui ; Bian, Jiang ; Guo, Yi ; Bost, Sarah ; Lyu, Tianchen ; Reynolds, Kristi ; Mefford, Matthew T. ; Zhou, Hui ; Zhou, Matt ; Lustigova, Eva ; Utidjian, Levon H. ; Maltenfort, Mitchell ; Kamboj, Manmohan ; Mendonca, Eneida A. ; Hanley, Patrick ; Zaganjor, Ibrahim ; Pavkov, Meda E. ; Rosenman, Marc ; Titus, Andrea R.
• Description:
  We discuss implications of potential ascertainment biases for studies examining diabetes risk following SARS-CoV-2 infection using electronic health records (EHRs). We quantitatively explore sensitivity of results to misclassification of COVID-19 status using data from the U.S.-based Diabetes in Children, Adolescents and Young Adults (DiCAYA) Network on children (≤17 years) and young adults (18-44 years).
  
  In our retrospective case study from the DiCAYA Network, SARS-CoV-2 was identified using labs and diagnoses from June 1, 2020 to December 31, 2021. Patients were followed through December 31, 2022 for new diabetes diagnoses. Sites examined incident diabetes by COVID-19 status using Cox proportional hazards models. Results were pooled in meta-analyses. A bias analysis examined potential impact of COVID-19 misclassification scenarios on results, guided by hypotheses that sensitivity would be <50% and would be higher among those who developed diabetes.
  
  Prevalence of documented COVID-19 was low overall and variable across sites (children: 4.4%-7.7%, young adults: 6.2%-22.7%). Individuals with documented COVID-19 were at higher risk of incident diabetes compared to those with no documented infection, but results were heterogeneous across sites. Findings were highly sensitive to COVID-19 misclassification assumptions. Observed results could be biased away from the null under several differential misclassification scenarios.
  
  Although EHR-based documentation of COVID-19 was associated with incident diabetes, COVID-19 phenotypes likely had low sensitivity, with considerable variation across sites. Misclassification assumptions strongly impacted interpretation of results.
  
  Given the potential for low phenotype sensitivity and misclassification, caution is warranted when interpreting analyses of COVID-19 and incident diabetes using clinical or administrative databases.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Electronic Health Records
  • COVID-19
  • Adult
  • Adolescent
  • Retrospective Studies
  • Young Adult
  • Child
  • Diabetes Mellitus
  • Phenotype
  More +
• Keywords:
  • Diabetes mellitus
  • COVID-19
  • SARS-CoV-2
  • electronic health records
  • misclassification
• Source:
  Journal of the American Medical Informatics Association: JAMIA, 2025, v. 33, no. 3
• DOI:
  https://doi.org/10.1093/jamia/ocaf229
• ISSN:
  1067-5027 ; 1527-974X
• Pubmed ID:
  41442443
• Pubmed Central ID:
  PMC12884381
• Document Type:
  Text
• Funding:
  U18 DP006693/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006510/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006513/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006694/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006509/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006506/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006518/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006500/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006517/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006633/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006512/DP/NCCDPHP CDC HHSUnited States/ ; U18 DP006521/DP/NCCDPHP CDC HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  United States
• Pages in Document:
  710-718 (17 pdf pages)
• Volume:
  33
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:ffcf0b0c7d2961746e3d54e234015cc4822bdeb93c18168013c3bf033ace6ec01def44e410a90867a40aea3b6143a2acd2c9c7b2f8bdfefb098620cbd1c30f3b