Representation of Social History Factors Across Age Groups: A Topic Analysis of Free-Text Social Documentation

As individuals age, there is potential for dramatic changes in the social and behavioral determinants that affect health status and outcomes. The importance of these determinants has been increasingly recognized in clinical decision-making. We sought to characterize how social and behavioral health determinants vary in different demographic groups using a previously established schema of 28 social history types through both manual analysis and automated topic analysis of social documentation in the electronic health record across the population of an entire integrated healthcare system. Our manual analysis generated 8,335 annotations over 1,400 documents, representing 24 (86%) social history types. In contrast, automated topic analysis generated 22 (79%) social history types. A comparative evaluation demonstrated both similarities and differences in coverage between the manual and topic analyses. Our findings validate the widespread nature of social and behavioral determinants that affect health status over populations of individuals over their lifespan.