Determining the Importance of Clinical Modalities for NeuroDegenerative Disorders and Risk of Patient Injury Using Machine Learning and Survival Analysis.

Falls among the elderly and especially those with NeuroDegenerative Disorders (NDD) reduces life expectancy. The purpose of this study is to explore the role of Machine Learning on Electronic Health Records (EHR) data for time-to-event survival analysis prediction of injuries, and role of sensitive attributes, e.g., Race, Ethnicity, Sex, in these models. We used multiple survival analysis methods on a cohort of 29,045 patients 65 years and older treated at PennMedicine for either NDD, Mild Cognitive Impairment (MCI), or another disease. We compare the algorithms and explore the role of multiple modalities on improving prediction of injuries among NDD patients, specifically medications and laboratory tests. Overall, we found that medication features resulted in either increased Hazard Ratios (HR) or reduced HR depending on the NDD type. We found that being of Black race significantly increased the risk offall/injury in the models that included only medication and sensitive attribute features. The combined model that used both modalities (medications and laboratory information) removed this relationship between being of Black race and increases in fall/injury. Therefore, we found that combining modalities in these survival models in the prediction offall/injury risk among NDD and MCI individuals results in findings that are robust to different Racial and Ethnic groups with no biases apparent in our final combined modality results. Furthermore, combining modalities (both medications and laboratory values) improved the survival analysis performance across multiple survival analysis methods, when compared using the C-index.