Where You Live Affects Your Treatment

A study of 250 million people in four countries found that patients with diabetes, hypertension, and depression often receive significantly different treatment depending on where they live.

Eleven groups of researchers used records from the Observational Health Data Sciences and Informatics program, establishing methods of equalizing the varying methods of collection and storing patient information to make the data usable for larger future studies.

The OHDSI contains more than 600 million patient records from 14 countries, including electronic health records, insurance claims and pharmacy records. The OHDSI is coordinated by researchers at Columbia University. The researchers hope the collection of data will allow for better design of clinical trials and treatment methods. The international project is aimed at gleaning insight into how people are treated, with the hope of providing more personalized and effective healthcare based on what works in the real world, as opposed to randomized clinical trials.

"The creation of such a network is a great opportunity, not only to characterize what treatments are actually being used, but also to attempt to identify what treatments are potentially better," Dr. Nigam Shah, an associate professor of medicine at Stanford University, said in a press release. "For example, from the wide variation in second-line treatments for diabetes, we can attempt to identify those that are more effective. OHDSI puts us on a path to creating personalized evidence, which is a form of precision medicine."

For the study, published in the Proceedings of the National Academy of Sciences, the researchers analyzed data on 250 million people in four countries receiving treatment for diabetes, hypertension and depression.

Among patients with diabetes, most are initially treated with the drug metformin, though secondary treatments vary significantly between patients. In hypertension and depression, initial treatments vary even more.

The researchers also found 10 percent of diabetes patients, 11 percent of depression patients and 24 percent of hypertension patients received paths of treatment different from all other patients whose records were analyzed in the study.

"We found that while the world is moving toward more consistent therapy over time for the three diseases, there remain significant differences in how they are treated," said Dr. George Hripcsak, chair of biomedical informatics at Columbia University Medical Center and principal investigator of the OHDSI coordinating center. "This suggests that randomized clinical trials -- the gold standard in evaluating new therapies -- may not capture enough of the information needed to make their results more broadly generalizable to different populations."