Population Estimates and Hypertension and Diabetes Prevalence: Cross-Sectional Quantitative Study Comparing...

Accurate small-area estimates of vaccination rates and disease burden can inform public health interventions.

This study aimed to compare population denominators derived from census data and electronic health record (EHR) data from a statewide collaboration in Minnesota and examine concordance between Centers for Disease Control and Prevention and EHR-based estimates of diabetes and hypertension prevalence at the census tract level.

A retrospective study was conducted using EHR data from 2018 to 2022 from the Minnesota EHR Consortium (MNEHRC), population estimates from the 2020 census, and disease prevalence estimates among adults from the Centers for Disease Control and Prevention Population Level Analysis and Community Estimates (PLACES) project. Patients were included if they had a Minnesota address and a clinic visit in the last 3 years. Patients with hypertension and diabetes were identified based on the presence of at least 1 diagnosis code in the Observational Medical Outcomes Partnership condition occurrence table in the last 5 years or an elevated outpatient blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) on 2 or more days in the last 3 years for hypertension or at least 1 hemoglobin A_1c value of ≥6.5 in the last 3 years for diabetes.

The 2020 census estimate for the population of Minnesota was 5,707,254. A total of 5,271,191 (92.4% of the census estimate) unique individuals visited 1 of the 11 MNEHRC health care systems in 3 years (2018-2020). The ratio of MNEHRC patients to the Minnesota statewide 2020 census estimate was higher for female individuals (0.97) than for male individuals (0.88) and higher for older age groups (individuals aged 65 years and older: 1.05) than for younger age groups (individuals aged 0-17 years: 0.83). The MNEHRC patient-to-census ratio also differed by race-the ratio was the highest for Black Minnesotans (1.17) and the lowest for American Indian and Alaska Native Minnesotans (0.68). According to MNEHRC data, the percentage of adults in Minnesota with diabetes in 2022 was 9.5% (415,914/4,376,805), and the percentage of adults in Minnesota with hypertension in 2021 was 32.2% (1,365,413/4,234,000). Estimates from PLACES for diabetes were 9.9% (435,481/4,389,028) and for hypertension were 29.9% (1,311,459/4,389,028). The percentage of census tracts where the MNEHRC estimate was within 10% of the PLACES estimate was 40.3% (605/1500) for diabetes and 42.3% (635/1500) for hypertension; 77.9% (1168/1500) of census tracts for diabetes and 79.7% (1195/1500) for hypertension were within 25% agreement.

Our analysis suggests that there are both similarities and important differences between small-area estimates derived from EHR and survey data. Such differences suggest that further research is needed to determine the optimal collection method for local estimates of health conditions.