Adolescent Health

Using Clinical Data to Study Womens HealthDeborah Ehrenthal, MDChristiana Care Health Services1Deborah Ehrenthal, MDChristiana Care Health SystemUsing Clinical Data to Study Womens Health2Retrospective cohort studiesStudies to measure the effectiveness of system changeLinking data to study the life course

Using Clinical Data to Study Womens Health

3Womens Health Across the Life Course4Breadth of Clinical Data at CCHS

5LimitationsYou work with the data you have, not the data you wish you had.Clinician determined outcomes can lead to some variation and difficulty quantifying disease severity.Data is collected for clinical purposes at variable intervals.Definitions can change over time.Challenging to pull data.

StrengthsLarge cohortReal world diversityReal world settingLower costShorter time-lineLimitations & Strengths

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Christiana Hospital (7538)55% of births in Delaware

Womens Health Group (1395)

Healthy Beginnings (533)Rich Data Source for Reproductive Age Women: CCHS Deliveries, 2008Clinical data for perinatal care has been warehoused since 1998A nearly population-based cohort of 7,000 women deliver at CCHSDemographically diverseIncludes:Includes demographic characteristics, socioeconomic markers, behaviors, medical diagnoses, pregnancy course and outcomesClinical practice is a vulnerable populationOutpatient EMR since 199?

7 Does the higher prevalence of medical co-morbidities among black women account for their increased risk of prematurity?

Ehrenthal DB, Jurkovitz C, Hoffman M, Kroelinger C, Weintraub W. A population study of the contribution of medical comorbidity to the risk of prematurity in blacks. Am J Obstet Gynecol. 2007 Oct;197(4):409 e1-6. Preterm birth rates, USMedical co-morbidity and the risk of prematurity in blacksBetter capture of medical risk factors than birth certificate data8NS = not significantORF= Overall risk factor. ORF=1: presence of one risk factor compared to no risk factorORF=2: presence of two risk factors or more compared to no risk factor* The ORs associated with the other age categories (30-39 and 40) are not significant except for the outcome Gestational Weeks