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Using Real-World Electronic Health Record Data to Assess Chronic Disease Screening in Children: A Case Study of
Emily M Kraus1,2, Samantha Lange Pierce1, Renee Porter1,3
1Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Insights
Pediatric non-alcoholic fatty liver disease (NAFLD) screening is infrequent despite guidelines. Electronic health records reveal common alanine aminotransferase (ALT) elevation in children with excess weight, highlighting the need for early detection.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Public Health
Background:
- Non-alcoholic fatty liver disease (NAFLD) is a growing concern in children, particularly those who are overweight or obese.
- Early detection of NAFLD is crucial to prevent liver damage, yet data on screening practices are limited.
- Current guidelines recommend alanine aminotransferase (ALT) screening for NAFLD in at-risk children aged nine and older.
Purpose of the Study:
- To assess the utilization of NAFLD screening via ALT testing in children with excess weight using real-world electronic health record (EHR) data.
- To determine the prevalence of elevated ALT levels among children undergoing NAFLD screening.
- To identify disparities in screening and ALT elevation based on age and sex.
Main Methods:
- Retrospective analysis of the IQVIA Ambulatory Electronic Medical Record database from January 1, 2019, to December 31, 2021.
- Inclusion criteria: patients aged 2-19 years with a body mass index (BMI) at or above the 85th percentile.
- Exclusion criteria: pre-existing liver disease or use of hepatotoxic medications (2017-2018). ALT elevation defined as ≥1 result ≥22.1 U/L (females) or ≥25.8 U/L (males).
Main Results:
- Only 13% of 919,203 patients aged 9-19 years had at least one ALT result recorded.
- ALT results were available for only 5% of patients aged 2-8 years.
- Among those with ALT results, 38% of patients aged 9-19 and 34% of patients aged 2-8 showed ALT elevation. Males aged 9-19 had a higher prevalence of ALT elevation (49%) compared to females (29%).
Conclusions:
- Despite screening recommendations, NAFLD screening via ALT testing is underutilized in children with excess weight.
- Elevated ALT levels are common among children who do receive screening, emphasizing the importance of this diagnostic tool.
- Real-world EHR data provide valuable insights into pediatric NAFLD screening practices and outcomes, supporting targeted interventions.
Abstract:
Data sources for assessing pediatric chronic diseases and associated screening practices are rare. One example is non-alcoholic fatty liver disease (NAFLD), a common chronic liver disease prevalent among children with overweight and obesity. If undetected, NAFLD can cause liver damage. Guidelines recommend screening for NAFLD using alanine aminotransferase (ALT) tests in children ≥9 years with obesity or those with overweight and cardiometabolic risk factors. This study explores how real-world data from electronic health records (EHRs) can be used to study NAFLD screening and ALT elevation. Using IQVIA's Ambulatory Electronic Medical Record database, we studied patients 2-19 years of age with body mass index ≥85th percentile. Using a 3-year observation period (January 1, 2019 to December 31, 2021), ALT results were extracted and assessed for elevation (≥1 ALT result ≥22.1 U/L for females and ≥25.8 U/L for males). Patients with liver disease (including NAFLD) or receiving hepatotoxic medications during 2017-2018 were excluded. Among 919,203 patients 9-19 years of age, only 13% had ≥1 ALT result, including 14% of patients with obesity and 17% of patients with severe obesity. ALT results were identified for 5% of patients 2-8 years of age. Of patients with ALT results, 34% of patients 2-8 years of age and 38% of patients 9-19 years of age had ALT elevation. Males 9-19 years of age had a higher prevalence of ALT elevation than females (49% vs. 29%). EHR data offered novel insights into NAFLD screening: despite screening recommendations, ALT results among children with excess weight were infrequent. Among those with ALT results, ALT elevation was common, underscoring the importance of screening for early disease detection.
