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Robustness of Multiple Imputation Methods for Missing Risk Factor Data from Electronic Medical Records for
Sanjoy K Paul1, Joanna Ling1,2, Mayukh Samanta1
1Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
Journal of Healthcare Informatics Research
|February 6, 2023
Summary
Multiple imputation methods reliably handle missing HbA1c data in electronic medical records for type 2 diabetes patients. These techniques ensure robust clinical inferences in pharmaco-epidemiological studies.
Area of Science:
- Pharmaco-epidemiology
- Biostatistics
- Diabetes Research
Background:
- Missing outcome data in electronic medical records (EMRs) poses challenges for observational studies.
- Appropriate imputation methodologies are crucial but often lacking for EMR data analysis.
- Type 2 diabetes patients treated with DPP-4 inhibitors or GLP-1 receptor agonists were analyzed.
Purpose of the Study:
- To evaluate imputation methodologies for missing HbA1c data in large EMR databases.
- To compare the robustness of multiple imputation (MI) techniques against complete case analysis.
- To identify predictors of missing HbA1c data in type 2 diabetes patients.
Main Methods:
- Utilized US EMR data from 38,483 patients on DPP-4 inhibitors and 8,977 on GLP-1 RAs.
- Compared multiple imputation by chained equations, two-fold MI (MI-2F), and MI with Markov Chain Monte Carlo.
- Analyzed predictors of missing HbA1c, including age and baseline HbA1c levels.
Main Results:
- Older patients (age quartiles Q3/Q4) and those with higher baseline HbA1c (≥7.5%) were less likely to have missing HbA1c data.
- All MI methods yielded similar HbA1c distributions and clinical inferences compared to complete case analyses.
- MI-2F showed marginally smaller differences between observed and imputed data with smaller standard errors.
Conclusions:
- Established MI techniques are reliable for imputing missing outcome data in large EMRs.
- These methods facilitate efficient study design and robust clinical inference in pharmaco-epidemiology.
- MI-2F demonstrated slight advantages in accuracy and precision for imputation.
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