title: Characterizing Adults Receiving Primary Medical Care in New York City: Implications for Using Electronic Health Records for Chronic Disease Surveillance.
abstract: Electronic health records (EHRs) from primary care providers can be used for chronic disease surveillance; however, EHR-based prevalence estimates may be biased toward people who seek care. This study sought to describe the characteristics of an in-care population and compare them with those of a not-in-care population to inform interpretation of EHR data.
  
  
  
  We used data from the 2013-2014 New York City Health and Nutrition Examination Survey (NYC HANES), considered the gold standard for estimating disease prevalence, and the 2013 Community Health Survey, and classified participants as in care or not in care, on the basis of their report of seeing a health care provider in the previous year. We used χ(2) tests to compare the distribution of demographic characteristics, health care coverage and access, and chronic conditions between the 2 populations.
  
  
  
  According to the Community Health Survey, approximately 4.1 million (71.7%) adults aged 20 or older had seen a health care provider in the previous year; according to NYC HANES, approximately 4.7 million (75.1%) had. In both surveys, the in-care population was more likely to be older, female, non-Hispanic, and insured compared with the not-in-care population. The in-care population from the NYC HANES also had a higher prevalence of diabetes (16.7% vs 6.9%; P < .001), hypercholesterolemia (35.7% vs 22.3%; P < .001), and hypertension (35.5% vs 26.4%; P < .001) than the not-in-care population.
  
  
  
  Systematic differences between in-care and not-in-care populations warrant caution in using primary care data to generalize to the population at large. Future efforts to use primary care data for chronic disease surveillance need to consider the intended purpose of data collected in these systems as well as the characteristics of the population using primary care.
authors.affiliation: New York City Department of Health and Mental Hygiene, Long Island City, New York, and City University of New York School of Public Health, New York, New York.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Romo
authors.affiliation: Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St, 07-99, Long Island City, New York, 11101-4132. Email: pchan7@health.nyc.gov.
authors.forename: Pui Ying
authors.initials: PY
authors.lastname: Chan
authors.affiliation: New York City Department of Health and Mental Hygiene, Long Island City, New York.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lurie-Moroni
authors.affiliation: New York City Department of Health and Mental Hygiene, Long Island City, New York.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Perlman
authors.affiliation: New York City Department of Health and Mental Hygiene, Long Island City, New York.
authors.forename: Remle
authors.initials: R
authors.lastname: Newton-Dame
authors.affiliation: City University of New York School of Public Health, New York, New York.
authors.forename: Lorna E
authors.initials: LE
authors.lastname: Thorpe
authors.affiliation: New York City Department of Health and Mental Hygiene, Long Island City, New York.
authors.forename: Katharine H
authors.initials: KH
authors.lastname: McVeigh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009749:Nutrition Surveys; D011159:Population Surveillance / Q000379:methods*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult