Measuring Exposure to Incarceration Using the Electronic Health Record.

Journal Article (Journal Article)


Electronic health records (EHRs) are a rich source of health information; however social determinants of health, including incarceration, and how they impact health and health care disparities can be hard to extract.


The main objective of this study was to compare sensitivity and specificity of patient self-report with various methods of identifying incarceration exposure using the EHR.

Research design

Validation study using multiple data sources and types.


Participants of the Veterans Aging Cohort Study (VACS), a national observational cohort based on data from the Veterans Health Administration (VHA) EHR that includes all human immunodeficiency virus-infected patients in care (47,805) and uninfected patients (99,060) matched on region, age, race/ethnicity, and sex.

Measures and data sources

Self-reported incarceration history compared with: (1) linked VHA EHR data to administrative data from a state Department of Correction (DOC), (2) linked VHA EHR data to administrative data on incarceration from Centers for Medicare and Medicaid Services (CMS), (3) VHA EHR-specific identifier codes indicative of receipt of VHA incarceration reentry services, and (4) natural language processing (NLP) in unstructured text in VHA EHR.


Linking the EHR to DOC data: sensitivity 2.5%, specificity 100%; linking the EHR to CMS data: sensitivity 7.9%, specificity 99.3%; VHA EHR-specific identifier for receipt of reentry services: sensitivity 7.3%, specificity 98.9%; and NLP, sensitivity 63.5%, specificity 95.9%.


NLP tools hold promise as a feasible and valid method to identify individuals with exposure to incarceration in EHR. Future work should expand this approach using a larger body of documents and refinement of the methods, which may further improve operating characteristics of this method.

Full Text

Duke Authors

Cited Authors

  • Wang, EA; Long, JB; McGinnis, KA; Wang, KH; Wildeman, CJ; Kim, C; Bucklen, KB; Fiellin, DA; Bates, J; Brandt, C; Justice, AC

Published Date

  • June 2019

Published In

Volume / Issue

  • 57 Suppl 6 Suppl 2 /

Start / End Page

  • S157 - S163

PubMed ID

  • 31095055

Pubmed Central ID

  • PMC8352066

Electronic International Standard Serial Number (EISSN)

  • 1537-1948

International Standard Serial Number (ISSN)

  • 0025-7079

Digital Object Identifier (DOI)

  • 10.1097/mlr.0000000000001049


  • eng