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Abstract
Understanding patient accumulation of comorbidities can facilitate healthcare strategy and personalized preventative care. We applied a directed network graph to electronic health record (EHR) data and characterized comorbidities in a cohort of healthy veterans undergoing screening colonoscopy. The Veterans Affairs Cooperative Studies Program #380 was a prospective longitudinal study of screening and surveillance colonoscopy. We identified initial instances of three-digit ICD-9 diagnoses for participants with at least 5 years of linked EHR history (October 1999 to December 2015). For diagnoses affecting at least 10% of patients, we calculated pairwise chronological relative risk (RR). iGraph was used to produce directed graphs of comorbidities with RR > 1, as well as summary statistics, key diseases, and communities. A directed graph based on 2210 patients visualized longitudinal development of comorbidities. Top hub (preceding) diseases included ischemic heart disease, inflammatory and toxic neuropathy, and diabetes. Top authority (subsequent) diagnoses were acute kidney failure and hypertensive chronic kidney failure. Four communities of correlated comorbidities were identified. Close analysis of top hub and authority diagnoses demonstrated known relationships, correlated sequelae, and novel hypotheses. Directed network graphs portray chronologic comorbidity relationships. We identified relationships between comorbid diagnoses in this aging veteran cohort. This may direct healthcare prioritization and personalized care.
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1 Durham VA Health Care System, Cooperative Studies Program Epidemiology Center-Durham, Durham, USA; University of California, Department of Radiation Oncology, San Francisco, USA (GRID:grid.266102.1) (ISNI:0000 0001 2297 6811); Bakar Computational Health Sciences Institute, University of California, San Francisco, USA (GRID:grid.266102.1) (ISNI:0000 0001 2297 6811)
2 Durham VA Health Care System, Cooperative Studies Program Epidemiology Center-Durham, Durham, USA (GRID:grid.266102.1); Duke University, Department of Biostatistics and Bioinformatics, Durham, USA (GRID:grid.26009.3d) (ISNI:0000 0004 1936 7961)
3 Durham VA Health Care System, Cooperative Studies Program Epidemiology Center-Durham, Durham, USA (GRID:grid.26009.3d)
4 Durham VA Health Care System, Cooperative Studies Program Epidemiology Center-Durham, Durham, USA (GRID:grid.26009.3d); Duke University, Department of Medicine, Durham, USA (GRID:grid.26009.3d) (ISNI:0000 0004 1936 7961)
5 Durham VA Health Care System, Cooperative Studies Program Epidemiology Center-Durham, Durham, USA (GRID:grid.26009.3d); Duke University, Department of Biostatistics and Bioinformatics, Durham, USA (GRID:grid.26009.3d) (ISNI:0000 0004 1936 7961)
6 Perry Point VA Medical Center, Cooperative Studies Program Coordinating Center, Perry Point, USA (GRID:grid.26009.3d)
7 VA Portland Health Care System, Portland, USA (GRID:grid.484322.b); Oregon Health and Science University, Portland, USA (GRID:grid.5288.7) (ISNI:0000 0000 9758 5690)
8 Durham VA Health Care System, Cooperative Studies Program Epidemiology Center-Durham, Durham, USA (GRID:grid.5288.7); Duke University, Department of Medicine, Durham, USA (GRID:grid.26009.3d) (ISNI:0000 0004 1936 7961)