Harnessing Electronic Health Records to Study Emerging Environmental Disasters: A Proof of Concept with Perfluoralkyl Substances (PFAS)

Abstract

ObjectiveEnvironmental disasters are anthropogenic catastrophic events that affect health. Famous disasters include the Chernobyl and Fukushima-Daiichi nuclear meltdowns, which had disastrous health consequences. Traditional methods for studying environmental disasters are costly and time-intensive. We propose the use of Electronic Health Records (EHR) and informatics methods to study the health effects of emergent environmental disasters in a cost-effective manner.Materials and MethodsAn emergent environmental disaster is exposure to Perfluoralkyl Substances (PFAS) in the Philadelphia area. Penn Medicine (PennMed) comprises multiple hospitals and facilities within the Philadelphia Metropolitan area, including over three thousand PFAS-exposed women living in one of the highest PFAS exposure areas nationwide. We developed a high-throughput method that utilizes only EHR data to evaluate the disease risk in this heavily exposed population.ResultsWe replicated all five disease/conditions implicated by PFAS exposure, including hypercholesterolemia, proteinuria, thyroid disease, kidney disease and colitis, either directly or via closely related diagnoses.DiscussionUsing EHRs coupled with informatics enables the health impacts of environmental disasters to be more easily studied in large cohorts versus traditional methods that rely on interviews and expensive serum-based testing. By reducing cost and increasing the diversity of individuals included in studies, we can overcome many of the hurdles faced by previous studies, including a lack of racial and ethnic diversity.ConclusionThis proof-of-concept study confirms that EHRs can be used to study human health and disease impacts of environmental disasters and produces equivalent disease-exposure knowledge to prospective epidemiology studies while remaining cost-effective.KEY MESSAGESElectronic Health Records can be used for studying health effects of environmental exposuresPFAS exposure - disease associations were mainly replicated using EHRsEHRs represent a cost-effective method to augment traditional epidemiology studies