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BackgroundThe rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal disease necessitating renal replacement therapy has placed a significant strain on health care. The rate of progression of CKD is influenced by both modifiable and unmodifiable risk factors. Identification of modifiable risk factors, such as lifestyle choices, is vital in informing strategies toward renoprotection. Modification of unhealthy lifestyle choices lessens the risk of CKD progression and associated comorbidities, although the lifestyle risk factors and modification strategies may vary with different comorbidities (eg, diabetes, hypertension). However, there are limited studies on suitable lifestyle interventions for CKD patients with comorbidities.ObjectiveThe objectives of our study are to (1) identify the lifestyle risk factors for CKD with common comorbid chronic conditions using a US nationwide survey in combination with literature mining, and (2) demonstrate the potential effectiveness of association rule mining (ARM) analysis for the aforementioned task, which can be generalized for similar tasks associated with noncommunicable diseases (NCDs).MethodsWe applied ARM to identify lifestyle risk factors for CKD progression with comorbidities (cardiovascular disease, chronic pulmonary disease, rheumatoid arthritis, diabetes, and cancer) using questionnaire data for 450,000 participants collected from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. The BRFSS is a Web-based resource, which includes demographic information, chronic health conditions, fruit and vegetable consumption, and sugar- or salt-related behavior. To enrich the BRFSS questionnaire, the Semantic MEDLINE Database was also mined to identify lifestyle risk factors.ResultsThe results suggest that lifestyle modification for CKD varies among different comorbidities. For example, the lifestyle modification of CKD with cardiovascular disease needs to focus on increasing aerobic capacity by improving muscle strength or functional ability. For CKD patients with chronic pulmonary disease or rheumatoid arthritis, lifestyle modification should be high dietary fiber intake and participation in moderate-intensity exercise. Meanwhile, the management of CKD patients with diabetes focuses on exercise and weight loss predominantly.ConclusionsWe have demonstrated the use of ARM to identify lifestyle risk factors for CKD with common comorbid chronic conditions using data from BRFSS 2017. Our methods can be generalized to advance chronic disease management with more focused and optimized lifestyle modification of NCDs.

Objective: The objective of this study is to demonstrate the feasibility of applying word embeddings to expand the terminology of dietary supplements (DS) using over 26 million clinical notes. Methods: Word embedding models (ie, word2vec and GloVe) trained on clinical notes were used to predefine a list of top 40 semantically related terms for each of 14 commonly used DS. Each list was further evaluated by experts to generate semantically similar terms. We investigated the effect of corpus size and other settings (ie, vector size and window size) as well as the 2 word embedding models on performance for DS term expansion. We compared the number of clinical notes (and patients they represent) that were retrieved using the word embedding expanded terms to both the baseline terms and external DS sources exandped terms. Results: Using the word embedding models trained on clinical notes, we could identify 1–12 semantically similar terms for each DS. Using the word embedding exandped terms, we were able to retrieve averagely 8.39% more clinical notes and 11.68% more patients for each DS compared with 2 sets of terms. The increasing corpus size results in more misspellings, but not more semantic variants brand names. Word2vec model is also found more capable of detecting semantically similar terms than GloVe. Conclusion: Our study demonstrates the utility of word embeddings on clinical notes for terminology expansion on 14 DS. We propose that this method can be potentially applied to create a DS vocabulary for downstream applications, such as information extraction.

The widespread prevalence of dietary supplements has drawn extensive attention due to the safety and efficacy issue. Clinical notes document a great amount of detailed information on dietary supplement usage, thus providing a rich source for clinical research on supplement safety surveillance. Identification the use status of dietary supplements is one of the initial steps for the ultimate goal of the supplement safety surveillance. In this study, we built rule-based and machine learning-based classifiers to automatically classify the use status of supplements into four categories: Continuing (C), Discontinued (D), Started (S), and Unclassified (U). In comparison to the machine learning classifier trained on the same datasets, the rule-based classifier showed a better performance with F-measure in the C, D, S, U status of 0.93, 0.98, 0.95, and 0.83, respectively. We further analyzed the errors generated by the rule-based classifier. The classifier can be potentially applied to extract supplement information from clinical notes for supporting research and clinical practice related to patient safety on supplement usage.