Natural language processing to identify reasons for sex disparity in statin prescriptions.
Natural language processing to identify reasons for sex disparity in statin prescriptions.
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DOI：
10.1016/j.ajpc.2023.100496
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发表时间：
2023-06
影响因子：
4.1
通讯作者：
Rodriguez, Fatima
中科院分区：
文献类型：
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作者：
Witting, Celeste;Azizi, Zahra;Gomez, Sofia Elena;Zammit, Alban;Sarraju, Ashish;Ngo, Summer;Hernandez-Boussard, Tina;Rodriguez, Fatima
他汀类药物是动脉粥样硬化性心血管疾病(ASCVD)患者治疗的基石。尽管如此，多项研究表明，患有ASCVD的女性服用他汀类药物的可能性低于男性。这项研究的目的是使用自然语言处理(NLP)来阐明造成这种差异的因素。我们的队列包括2014至2021年间两次或两次以上遭遇ASCVD的成年患者，这些患者在北加州的多站点电子健康记录(EHR)中被诊断为ASCVD。在回顾了结构化的EHR处方数据后，我们使用了一种基准深度学习NLP方法，即Transformers的临床双向编码器表示法(BERT)，来识别和解释临床笔记中记录的他汀类药物处方的讨论。在20%的测试集上，对照专家临床医生评审对临床BERT进行评估。ASCVD患者88,913例，平均年龄(67.8±13.1)岁，女性35,901例(40.4%)。与男性相比，患有ASCVD的女性更不可能开他汀类药物(56.6%比67.6%，p<；0.001)，而且当开出处方时，更不可能开指南指导的高强度剂量(41.4%比49.8%，p<；0.001)。这些差异在较年轻的患者、有私人保险的患者和那些英语为首选语言的患者中更加明显。在那些没有开他汀类药物的患者中，女性在临床记录中提到他汀类药物的可能性低于男性(16.9%比19.1%，p<；0.001)。尽管没有记录的处方，但女性在临床记录中使用他汀类药物的可能性低于男性(32.8%对42.6%，p<；0.001)。女性在结构化数据或临床记录中记录他汀类药物不耐受的可能性略高于男性(6.0%比5.3%，p=0.003)。与男性相比，患有ASCVD的女性更不可能服用指南指导的他汀类药物。NLP在ASCVD患者的临床记录中发现了额外的基于性别的他汀类药物差异和他汀类药物非处方药的原因。
Statins are the cornerstone of treatment of patients with atherosclerotic cardiovascular disease (ASCVD). Despite this, multiple studies have shown that women with ASCVD are less likely to be prescribed statins than men. The objective of this study was to use Natural Language Processing (NLP) to elucidate factors contributing to this disparity. Our cohort included adult patients with two or more encounters between 2014 and 2021 with an ASCVD diagnosis within a multisite electronic health record (EHR) in Northern California. After reviewing structured EHR prescription data, we used a benchmark deep learning NLP approach, Clinical Bidirectional Encoder Representations from Transformers (BERT), to identify and interpret discussions of statin prescriptions documented in clinical notes. Clinical BERT was evaluated against expert clinician review in 20% test sets. There were 88,913 patients with ASCVD (mean age 67.8±13.1 years) and 35,901 (40.4%) were women. Women with ASCVD were less likely to be prescribed statins compared with men (56.6% vs 67.6%, p <0.001), and, when prescribed, less likely to be prescribed guideline-directed high-intensity dosing (41.4% vs 49.8%, p <0.001). These disparities were more pronounced among younger patients, patients with private insurance, and those for whom English is their preferred language. Among those not prescribed statins, women were less likely than men to have statins mentioned in their clinical notes (16.9% vs 19.1%, p <0.001). Women were less likely than men to have statin use reported in clinical notes despite absence of recorded prescription (32.8% vs 42.6%, p <0.001). Women were slightly more likely than men to have statin intolerance documented in structured data or clinical notes (6.0% vs 5.3%, p=0.003). Women with ASCVD were less likely to be prescribed guideline-directed statins compared with men. NLP identified additional sex-based statin disparities and reasons for statin non-prescription in clinical notes of patients with ASCVD.