Data for Community Health Assessment in Rural Colorado: A Comparison of Electronic Health Records to Public Health Surveys to Describe Childhood Obesity

Abstract

Context: Community-level data are necessary to inform community health assessments and to plan for appropriate interventions. However, data derived from public health surveys may be limited or unavailable in rural locations.

Objective: We compared 2 sources of data for community health assessment in rural Colorado, electronic health records (EHRs) and routine public health surveys.

Design: Comparison of cross-sectional measures of childhood/youth obesity prevalence and data quality.

Setting: Two rural Colorado counties, La Plata and Prowers.

Participants: The EHR cohort comprised patients 2 to 19 years of age who underwent a visit with the largest health care provider in each county. These data included sex, age, weight, height, race, ethnicity, and insurance status. Public health survey data were obtained from 2 surveys, the Colorado Child Health Survey (2-14 years of age) and the Healthy Kids Colorado Survey (15-19 years of age) and included caregiver and self-reported height and weight estimates.

Main outcome measures: We calculated body mass index percentile for each patient and survey respondent and determined overweight/obesity prevalence by county. We evaluated data source quality indicators according to a rubric developed for this analysis.

Results: The EHR sample captured approximately 35% (n = 3965) and 70% (n = 2219) of all children living in La Plata and Prowers Counties, respectively. The EHR prevalence estimates of overweight/obesity were greater in precision than survey data in both counties among children 2 to 14 years of age. In addition, the EHR data were more timely and geographically representative than survey data and provided directly measured height and weight. Conversely, survey data were easier to access and more demographically representative of the overall population.

Conclusions: Electronic health records describing the prevalence of obesity among children/youth living in rural Colorado may complement public health survey data for community health assessment and health improvement planning.