title: Comparison of the information provided by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity.
abstract: BACKGROUND
  Health surveys (HS) are a well-established methodology for measuring the health status of a population. The relative merit of using information based on HS versus electronic health records (EHR) to measure multimorbidity has not been established. Our study had two objectives: 1) to measure and compare the prevalence and distribution of multimorbidity in HS and EHR data, and 2) to test specific hypotheses about potential differences between HS and EHR reporting of diseases with a symptoms-based diagnosis and those requiring diagnostic testing.
  
  
  METHODS
  Cross-sectional study using data from a periodic HS conducted by the Catalan government and from EHR covering 80% of the Catalan population aged 15 years and older. We determined the prevalence of 27 selected health conditions in both data sources, calculated the prevalence and distribution of multimorbidity (defined as the presence of ≥2 of the selected conditions), and determined multimorbidity patterns. We tested two hypotheses: a) health conditions requiring diagnostic tests for their diagnosis and management would be more prevalent in the EHR; and b) symptoms-based health problems would be more prevalent in the HS data.
  
  
  RESULTS
  We analysed 15,926 HS interviews and 1,597,258 EHRs. The profile of the EHR sample was 52% women, average age 47 years (standard deviation: 18.8), and 68% having at least one of the selected health conditions, the 3 most prevalent being hypertension (20%), depression or anxiety (16%) and mental disorders (15%). Multimorbidity was higher in HS than in EHR data (60% vs. 43%, respectively, for ages 15-75+, P <0.001, and 91% vs. 83% in participants aged ≥65 years, P <0.001). The most prevalent multimorbidity cluster was cardiovascular. Circulation disorders (other than varicose veins), chronic allergies, neck pain, haemorrhoids, migraine or frequent headaches and chronic constipation were more prevalent in the HS. Most symptomatic conditions (71%) had a higher prevalence in the HS, while less than a third of conditions requiring diagnostic tests were more prevalent in EHR.
  
  
  CONCLUSIONS
  Prevalence of multimorbidity varies depending on age and the source of information. The prevalence of self-reported multimorbidity was significantly higher in HS data among younger patients; prevalence was similar in both data sources for elderly patients. Self-report appears to be more sensitive to identifying symptoms-based conditions. A comprehensive approach to the study of multimorbidity should take into account the patient perspective.
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain. cviolan@idiapjgol.org
authors.forename: Concepción
authors.initials: C
authors.lastname: Violán
authors.forename: Quintí
authors.initials: Q
authors.lastname: Foguet-Boreu
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hermosilla-Pérez
authors.forename: Jose M
authors.initials: JM
authors.lastname: Valderas
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Bolíbar
authors.forename: Mireia
authors.initials: M
authors.lastname: Fàbregas-Escurriola
authors.forename: Pilar
authors.initials: P
authors.lastname: Brugulat-Guiteras
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Muñoz-Pérez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015995:Prevalence; D011320:Primary Health Care; D013030:Spain / Q000453:epidemiology