The Patient Outcomes Research To Advance Learning (PORTAL) Network Adult Overweight and Obesity Cohort: Development and Description.
BACKGROUND
The Patient-Centered Outcomes Research Institute (PCORI) created a new national network infrastructure to enable large-scale observational comparative effectiveness research across diverse clinical care settings. As part of testing the feasibility of this effort, each clinical data research network (CDRN) was required to construct cohorts of patients, including one of patients with overweight and obesity.


OBJECTIVE
The aim of this paper is to report on the development of the Patient Outcomes Research to Advance Learning (PORTAL) overweight and obese cohort, which includes patients from 10 health plans located across the United States.


METHODS
Information was gathered from each plan's electronic health records (EHR). Eligibility included 18 years of age or older, a valid height and weight in 2012 or 2013, and body mass index (BMI) greater than 22.9 kg/m(2). Pre-diabetes and diabetes status was defined using the American Diabetes Association (ADA) criteria, using lab values of glycated hemoglobin (HbA1c) or fasting glucose available in the EHR. Hypertension was identified from the International Classification of Diseases (ICD) diagnosis codes. Individuals were classified into BMI categories: healthy weight (23.0-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), obese class 1 (30.0-34.9 kg/m(2)), obese class 2 (35.0-39.9 kg/m(2)), obese class 3 (40.0-49.0 kg/m(2)), and obese class 4 (>50.0 kg/m(2)).


RESULTS
A cohort of 5,293,458 non-pregnant adults was created. Weight status was 20.39% (1,079,289/5,293,458) healthy weight, 40.40% (2,138,520/5,293,458) overweight, 22.78% (1,205,866/5,293,458) obese class 1, 9.86% (521,872/5,293,458) obese class 2, 5.59% (295,786/5,293,458) obese class 3, and 0.98% (52,125/5,293,458) obese class 4. Race/ethnicity was 49.02% (2,594,776/5,293,458) non-Hispanic white, 22.89% (1,211,677/5,293,458) Hispanic, 10.40% (550,608/5,293,458) Asian, 10.83% (573,506/5,293,458) black, and 6.59% (348,830/5,293,458) other. About 34.33% (1,817,438/5,293,458) met the definition of hypertension, 20.49% (1,660,940/5,293,458) of individuals met the criteria for pre-diabetes, and 14.98% (793,069/5,293,458) met criteria for diabetes. Prevalence of pre-diabetes and diabetes varied across health plans to a greater extent than expected based on hypertension prevalence and BMI status variability.


CONCLUSIONS
This large, race, ethnic, and geographically diverse cohort will be useful for future studies of rare exposures or outcomes and differences in health care practices.
Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States. deborah.r.young@kp.org.
Deborah R
http://orcid.org/0000-0002-8335-7851
DR
Young
Beth A
http://orcid.org/0000-0003-2134-1958
BA
Waitzfelder
David
http://orcid.org/0000-0002-5208-8492
D
Arterburn
Gregory A
http://orcid.org/0000-0002-7563-6236
GA
Nichols
Assiamira
http://orcid.org/0000-0002-7505-4826
A
Ferrara
Corinna
http://orcid.org/0000-0001-8274-0309
C
Koebnick
Ayae
http://orcid.org/0000-0003-3300-8001
A
Yamamoto
Matthew F
http://orcid.org/0000-0003-1309-4096
MF
Daley
Nancy E
http://orcid.org/0000-0002-3365-9018
NE
Sherwood
Michael A
http://orcid.org/0000-0002-6971-7646
MA
Horberg
Lee
http://orcid.org/0000-0003-1657-516X
L
Cromwell
Kristina H
http://orcid.org/0000-0002-4921-7230
KH
Lewis
diabetes; obesity; overweight; pre-diabetes; race and ethnic diversity