The Effect of Epidemiological Cohort Creation on the Machine Learning Prediction of Homelessness and Police Interaction Outcomes Using Administrative Health Care Data

TL;DR

This study demonstrates that using flexible, adaptive observation windows in cohort creation enhances the performance of machine learning models in predicting homelessness and police interactions among individuals with mental health issues, compared to fixed windows.

Contribution

It introduces a flexible cohort creation method that improves predictive accuracy of ML models for adverse outcomes in mental health populations.

Findings

XGBoost outperformed other models with 91% sensitivity and 90% AUC.

Flexible windows improved model performance over fixed observation periods.

Key risk factors include male sex, substance disorder, and psychiatric visits.

Abstract

Background: Mental illness can lead to adverse outcomes such as homelessness and police interaction and understanding of the events leading up to these adverse outcomes is important. Predictive models may help identify individuals at risk of such adverse outcomes. Using a fixed observation window cohort with logistic regression (LR) or machine learning (ML) models can result in lower performance when compared with adaptive and parcellated windows. Method: An administrative healthcare dataset was used, comprising of 240,219 individuals in Calgary, Alberta, Canada who were diagnosed with addiction or mental health (AMH) between April 1, 2013, and March 31, 2018. The cohort was followed for 2 years to identify factors associated with homelessness and police interactions. To understand the benefit of flexible windows to predictive models, an alternative cohort was created. Then LR and ML models, including random forests (RF), and extreme gradient boosting (XGBoost) were compared in the two cohorts. Results: Among 237,602 individuals, 0.8% (1,800) experienced first homelessness, while 0.32% (759) reported initial police interaction among 237,141 individuals. Male sex (AORs: H=1.51, P=2.52), substance disorder (AORs: H=3.70, P=2.83), psychiatrist visits (AORs: H=1.44, P=1.49), and drug abuse (AORs: H=2.67, P=1.83) were associated with initial homelessness (H) and police interaction (P). XGBoost showed superior performance using the flexible method (sensitivity =91%, AUC =90% for initial homelessness, and sensitivity =90%, AUC=89% for initial police interaction) Conclusion: This study identified key features associated with initial homelessness and police interaction and demonstrated that flexible windows can improve predictive modeling.