• Alexandra K Lee, Bocheng Jing, Sun Y Jeon, W John Boscardin, and Sei J Lee.
• Division of Geriatrics, University of California, 4150 Clement St, VA181G, San Francisco, CA, 94121, USA. alexandra.lee@ucsf.edu.
• J Gen Intern Med. 2022 Feb 1; 37 (3): 499506499-506.

BackgroundGuidelines recommend breast and colorectal cancer screening for older adults with a life expectancy >10 years. Most mortality indexes require clinician data entry, presenting a barrier for routine use in care. Electronic health records (EHR) are a rich clinical data source that could be used to create individualized life expectancy predictions to identify patients for cancer screening without data entry.ObjectiveTo develop and internally validate a life expectancy calculator from structured EHR data.DesignRetrospective cohort study using national Veteran's Affairs (VA) EHR databases.PatientsVeterans aged 50+ with a primary care visit during 2005.Main MeasuresWe assessed demographics, diseases, medications, laboratory results, healthcare utilization, and vital signs 1 year prior to the index visit. Mortality follow-up was complete through 2017. Using the development cohort (80% sample), we used LASSO Cox regression to select ~100 predictors from 913 EHR data elements. In the validation cohort (remaining 20% sample), we calculated the integrated area under the curve (iAUC) and evaluated calibration.Key ResultsIn 3,705,122 patients, the mean age was 68 years and the majority were male (97%) and white (85%); nearly half (49%) died. The life expectancy calculator included 93 predictors; age and gender most strongly contributed to discrimination; diseases also contributed significantly while vital signs were negligible. The iAUC was 0.816 (95% confidence interval, 0.815, 0.817) with good calibration.ConclusionsWe developed a life expectancy calculator using VA EHR data with excellent discrimination and calibration. Automated life expectancy prediction using EHR data may improve guideline-concordant breast and colorectal cancer screening by identifying patients with a life expectancy >10 years.© 2021. Society of General Internal Medicine.

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