title: Using electronic health records data to assess comorbidities of substance use and psychiatric diagnoses and treatment settings among adults.
abstract: OBJECTIVE
  To examine prevalences of substance use disorders (SUD) and comprehensive patterns of comorbidities among psychiatric patients ages 18-64 years (N = 40,099) in an electronic health records (EHR) database.
  
  
  METHODS
  DSM-IV diagnoses among psychiatric patients in a large university system were systematically captured: SUD, anxiety (AD), mood (MD), personality (PD), adjustment, childhood-onset, cognitive/dementia, dissociative, eating, factitious, impulse-control, psychotic (schizophrenic), sexual/gender identity, sleep, and somatoform diagnoses. Comorbidities and treatment types among patients with a SUD were examined.
  
  
  RESULTS
  Among all patients, 24.9% (n = 9984) had a SUD, with blacks (35.2%) and Hispanics (32.9%) showing the highest prevalence. Among patients with a SUD, MD was prevalent across all age groups (50.2-56.6%). Patients aged 18-24 years had elevated odds of comorbid PD, adjustment, childhood-onset, impulse-control, psychotic, and eating diagnoses. Females had more PD, AD, MD, eating, and somatoform diagnoses, while males had more childhood-onset, impulse-control, and psychotic diagnoses. Blacks had greater odds than whites of psychotic and cognitive/dementia diagnoses, while whites exhibited elevated odds of PA, AD, MD, childhood-onset, eating, somatoform, and sleep diagnoses. Women, blacks, and Native American/multiple-race adults had elevated odds of using inpatient treatment; men, blacks, and Hispanics had increased odds of using psychiatric emergency care. Comorbid MD, PD, adjustment, somatoform, psychotic, or cognitive/dementia diagnoses increased inpatient treatment.
  
  
  CONCLUSIONS
  Patients with a SUD, especially minority members, use more inpatient or psychiatric emergency care than those without. Findings provide evidence for research on understudied diagnoses and underserved populations in the real-world clinical settings.
authors: Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Box 3903, Durham, NC 27710, USA. litzy.wu@duke.edu
authors: Li-Tzy
authors: LT
authors: Wu
authors: Kenneth R
authors: KR
authors: Gersing
authors: Marvin S
authors: MS
authors: Swartz
authors: Bruce
authors: B
authors: Burchett
authors: Ting-Kai
authors: TK
authors: Li
authors: Dan G
authors: DG
authors: Blazer
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D015995:Prevalence; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult