Currently accepted at: JMIR Public Health and Surveillance
Date Submitted: Oct 22, 2025
Open Peer Review Period: Oct 24, 2025 - Dec 19, 2025
Date Accepted: Mar 25, 2026
(closed for review but you can still tweet)
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/86337
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Differences in Population Estimates and Disease Prevalence: Comparing EHR-Derived Counts to the Census and CDC PLACES
ABSTRACT
Background:
Accurate small area estimates of vaccination rates and disease burden can inform public health interventions.
Objective:
To compare population denominators derived from census data and electronic health record (EHR) data from a statewide collaboration in Minnesota and examine concordance between CDC and EHR-based estimates of diabetes and hypertension prevalence at the census tract level.
Methods:
Retrospective study utilizing EHR data from 2018-2022 from the Minnesota EHR Consortium (MNEHRC), population estimates from 2020 census data, and disease prevalence estimates among adults from the Centers for Disease Control and Prevention (CDC) Population Level Analysis and Community Estimates (PLACES) project. Patients were included if they had a Minnesota address and a clinic visit in the last 3 years. Patients with hypertension and diabetes were identified based on the presence of at least one diagnosis code in the OMOP condition occurrence table in the last five years or an elevated outpatient blood pressure (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) on two or more days in the last three years for hypertension or at least one A1c ≥6.5 in the last three years for diabetes.
Results:
There were 5,271,191 unique individuals who had a visit in the last three years (2018-2020) at one of the 11 MNEHRC healthcare systems. This represents 92% of the 2020 census estimate for Minnesota (5,707,254). The ratio of MNEHRC patients to the Minnesota statewide 2020 census estimate was higher for females (0.97) than males (0.88) and higher for older age groups (age 65 years and older: 1.05) than younger age groups (age 0-17 years: 0.83). The MNEHRC patient to census ratio also differed by race – the ratio was highest for Black Minnesotans (1.17) and lowest for American Indian/Alaska Native Minnesotans (0.68). According to MNEHRC data, the number of adults in Minnesota with diabetes was 415,914 (9.5%) and the number with hypertension was 1,365,413 (32%). Estimates from PLACES for diabetes was 435,481 (9.9%) and for hypertension was 1,311,459 (30%). The percent of census tracts where the MNEHRC estimate was within 10% of the PLACES estimate was 40% for diabetes and 42% for hypertension 78% and 80% were within 25% respectively.
Conclusions:
Our analysis suggests that there are both similarities, as well as important differences between small-area estimates derived from EHR and survey data. Such differences suggest further research is needed to determine the optimal collection method for local estimates of health conditions.
Citation
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Copyright
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