Variational Bayes latent class approach for EHR-based phenotyping with large real-world data

Bayesian approaches to clinical analyses for the purposes of patient phenotyping have been limited by the computational challenges associated with applying the Markov-Chain Monte-Carlo (MCMC) approach to large real-world data. Approximate Bayesian inference via optimization of the variational evidence lower bound, often called Variational Bayes (VB), has been successfully demonstrated for other applications. We investigate the performance and characteristics of currently available R and Python VB software for variational Bayesian Latent Class Analysis (LCA) of realistically large real-world observational data. We used a real-world data set, Optum\textsuperscript{TM} electronic health records (EHR), containing pediatric patients with risk indicators for type 2 diabetes mellitus that is a rare form in pediatric patients. The aim of this work is to validate a Bayesian patient phenotyping model for generality and extensibility and crucially that it can be applied to a realistically large real-world clinical data set. We find currently available automatic VB methods are very sensitive to initial starting conditions, model definition, algorithm hyperparameters and choice of gradient optimiser. The Bayesian LCA model was challenging to implement using VB but we achieved reasonable results with very good computational performance compared to MCMC.