title: Linking electronic health records with community-level data to understand childhood obesity risk.
abstract: BACKGROUND
  Environmental and socioeconomic factors should be considered along with individual characteristics when determining risk for childhood obesity.
  
  
  OBJECTIVE
  To assess relationships and interactions among the economic hardship index (EHI) and race/ethnicity, age and sex in regard to childhood obesity rates in Wisconsin children using an electronic health record dataset.
  
  
  METHODS
  Data were collected using the University of Wisconsin (UW) Public Health Information Exchange database, which links electronic health records with census-derived community-level data. Records from 53,775 children seen at UW clinics from 2007 to 2012 were included. Mixed-effects modelling was used to determine obesity rates and the interaction of EHI with covariates (race/ethnicity, age, sex). When significant interactions were determined, linear regression analyses were performed for each subgroup (e.g. by age groups).
  
  
  RESULTS
  The overall obesity rate was 11.7% and significant racial/ethnic disparities were detected. Childhood obesity was significantly associated with EHI at the community level (r = 0.62, P < 0.0001). A significant interaction was determined between EHI and both race/ethnicity and age on obesity rates.
  
  
  CONCLUSIONS
  Reducing economic disparities and improving environmental conditions may influence childhood obesity risk in some, but not all, races and ethnicities. Furthermore, the impact of EHI on obesity may be compounded over time. Our findings demonstrate the utility of linking electronic health information with census data to rapidly identify community-specific risk factors in a cost-effective manner.
authors.affiliation: College of Agricultural & Life Sciences, Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA.
authors.forename: E J
authors.identifier: http://orcid.org/0000-0002-9074-0875
authors.initials: EJ
authors.lastname: Tomayko
authors.affiliation: School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Flood
authors.affiliation: School of Medicine and Public Health, Department of Family Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: A
authors.initials: A
authors.lastname: Tandias
authors.affiliation: School of Medicine and Public Health, Department of Family Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: L P
authors.initials: LP
authors.lastname: Hanrahan
mesh_terms: D000293:Adolescent; D002648:Child; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011203:Poverty; D011634:Public Health; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014922:Wisconsin / Q000453:epidemiology
keywords: Childhood obesity; economic hardship; electronic health records; social determinants