Leveraging a health information exchange for analyses of COVID-19 outcomes including an example application using smoking history and mortality

Guillermo A. Tortolero, Michael R. Brown, Shreela V. Sharma, Marcia C. de Oliveira Otto, Jose Miguel Yamal, David Aguilar, Matt D. Gunther, Dania I. Mofleh, Rachel D. Harris, Jemima C. John, Paul S. de Vries, Ryan Ramphul, Dritana Marko Serbo, Jennifer Kiger, Deborah Banerjee, Nick Bonvino, Angela Merchant, Warren Clifford, Jenny Mikhail, Hua XuRobert E. Murphy, Qiang Wei, Farhaan S. Vahidy, Alanna C. Morrison, Eric Boerwinkle

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 is critically important, and requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up. A large Health Information Exchange (HIE) in Southeast Texas, which assembles and shares electronic health information among providers to facilitate patient care, was leveraged to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes. The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic’s onset to June 12th, 2020 and was created for the analyses shown here. We gathered demographic, lifestyle, laboratory, and clinical data from patient’s encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities. Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, over 26% were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older (odds ratio = 1.07, 95% CI 1.06, 1.08), male (1.91, 95% CI 1.58, 2.31), and had a history of tobacco use (2.45, 95% CI 1.93, 3.11). History of tobacco use remained significantly associated (1.65, 95% CI 1.27, 2.13) with COVID-19 fatality after adjusting for age, gender, and race/ethnicity. This effort demonstrates the impact of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across disparate healthcare providers electronic health record (HER) systems, and follow the cohort over time. These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.

Original languageEnglish (US)
Article numbere0247235
Pages (from-to)e0247235
JournalPLoS ONE
Issue number6 June
StatePublished - Jun 2021


  • Age Factors
  • COVID-19/mortality
  • Cohort Studies
  • Comorbidity
  • Ethnic Groups
  • Health Information Exchange/statistics & numerical data
  • Healthcare Disparities
  • Hospitalization
  • Humans
  • Pandemics
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2/metabolism
  • Sex Factors
  • Smoking
  • Texas

ASJC Scopus subject areas

  • General


Dive into the research topics of 'Leveraging a health information exchange for analyses of COVID-19 outcomes including an example application using smoking history and mortality'. Together they form a unique fingerprint.

Cite this