BACKGROUND: Negative descriptors in electronic health records (EHR) contribute to worse health outcomes; studies show they are also more prevalent in EHRs of women and racial minorities and affect downstream research biases. Similar and unique patterns of negative descriptors may also exist in the records of blind patients, including those with diabetic retinopathy. Diabetic retinopathy is a preventable but leading cause of blindness in the US that is disproportionally high among women and racial and ethnic minorities. METHODS: Using EHR from a large medical center, we created "matched" cohorts of patients with a type 2 diabetes-only diagnosis and patients with a diagnosis of diabetic retinopathy. We identified previously used and new, disability and patient-related negative descriptors and assessed patterns of biased language in the EHR, comparing patients by retinopathy diagnosis (yes/no), and changes in patterns of language usage pre- and post- the retinopathy diagnosis. We also assessed differences between patients with type 2 diabetes at the intersection of blindness (ie, retinopathy diagnosis) and self-reported gender and race and ethnicity marginalization. RESULTS: The EHRs of patients with diabetic retinopathy were significantly more likely than those of patients with diabetes-only diagnoses to contain biased language, across queried negative descriptors. The biasing language was consistently more prevalent in EHRs of patients with diabetic retinopathy identifying as women, Black/African Americans and Hispanic compared to White men and more likely to occur following patients' retinopathy diagnosis. CONCLUSIONS: Our study indicates the presence of both disability- and intersectional biases in EHRs. We discuss findings' implications and suggest steps to address them.

Summary: Comprehensive 2D gas chromatography-mass spectrometry is a powerful method for analyzing complex mixtures of volatile compounds, but produces a large amount of raw data that requires downstream processing to align signals of interest (peaks) across multiple samples and match peak characteristics to reference standard libraries prior to downstream statistical analysis. Very few existing tools address this aspect of analysis and those that do have shortfalls in usability or performance. We have developed an R package that implements retention time and mass spectra similarity threshold-free alignments, seamlessly integrates retention time standards for universally reproducible alignments, performs common ion filtering and provides compatibility with multiple peak quantification methods. We demonstrate that our package's performance compares favorably to existing tools on a controlled mix of metabolite standards separated under variable chromatography conditions and data generated from cell lines. Availability and implementation: R2DGC can be downloaded at https://github.com/rramaker/R2DGC or installed via the Comprehensive R Archive Network (CRAN). Contact: [email protected]. Supplementary information: Supplementary data are available at Bioinformatics online.