A Systematic Review of Re-Identification Attacks on Health Data
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{"title"=>"A systematic review of re-identification attacks on health data", "type"=>"generic", "authors"=>[{"first_name"=>"Khaled", "last_name"=>"El Emam", "scopus_author_id"=>"7004609665"}, {"first_name"=>"Elizabeth", "last_name"=>"Jonker", "scopus_author_id"=>"22979616500"}, {"first_name"=>"Luk", "last_name"=>"Arbuckle", "scopus_author_id"=>"54791914100"}, {"first_name"=>"Bradley", "last_name"=>"Malin", "scopus_author_id"=>"6602093073"}], "year"=>2011, "source"=>"PLoS ONE", "identifiers"=>{"scopus"=>"2-s2.0-82555187188", "sgr"=>"82555187188", "issn"=>"19326203", "doi"=>"10.1371/journal.pone.0028071", "pmid"=>"22164229", "isbn"=>"1932-6203; 1932-6203", "pui"=>"363025028"}, "id"=>"f57639d8-27c4-328b-9880-9968efdc508b", "abstract"=>"BACKGROUND: Privacy legislation in most jurisdictions allows the disclosure of health data for secondary purposes without patient consent if it is de-identified. Some recent articles in the medical, legal, and computer science literature have argued that de-identification methods do not provide sufficient protection because they are easy to reverse. Should this be the case, it would have significant and important implications on how health information is disclosed, including: (a) potentially limiting its availability for secondary purposes such as research, and (b) resulting in more identifiable health information being disclosed. Our objectives in this systematic review were to: (a) characterize known re-identification attacks on health data and contrast that to re-identification attacks on other kinds of data, (b) compute the overall proportion of records that have been correctly re-identified in these attacks, and (c) assess whether these demonstrate weaknesses in current de-identification methods.\\n\\nMETHODS AND FINDINGS: Searches were conducted in IEEE Xplore, ACM Digital Library, and PubMed. After screening, fourteen eligible articles representing distinct attacks were identified. On average, approximately a quarter of the records were re-identified across all studies (0.26 with 95% CI 0.046-0.478) and 0.34 for attacks on health data (95% CI 0-0.744). There was considerable uncertainty around the proportions as evidenced by the wide confidence intervals, and the mean proportion of records re-identified was sensitive to unpublished studies. Two of fourteen attacks were performed with data that was de-identified using existing standards. Only one of these attacks was on health data, which resulted in a success rate of 0.00013.\\n\\nCONCLUSIONS: The current evidence shows a high re-identification rate but is dominated by small-scale studies on data that was not de-identified according to existing standards. This evidence is insufficient to draw conclusions about the efficacy of de-identification methods.", "link"=>"http://www.mendeley.com/research/systematic-review-reidentification-attacks-health-data", "reader_count"=>136, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>8, "Librarian"=>2, "Researcher"=>33, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>34, "Student > Postgraduate"=>6, "Student > Master"=>23, "Other"=>9, "Student > Bachelor"=>7, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>1, "Professor"=>3}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>8, "Librarian"=>2, "Researcher"=>33, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>34, "Student > Postgraduate"=>6, "Student > Master"=>23, "Other"=>9, "Student > Bachelor"=>7, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>1, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>7, "Agricultural and Biological Sciences"=>10, "Philosophy"=>1, "Arts and Humanities"=>1, "Veterinary Science and Veterinary Medicine"=>1, "Business, Management and Accounting"=>1, "Computer Science"=>60, "Engineering"=>5, "Biochemistry, Genetics and Molecular Biology"=>3, "Mathematics"=>3, "Medicine and Dentistry"=>25, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Physics and Astronomy"=>3, "Psychology"=>2, "Social Sciences"=>10, "Linguistics"=>1, "Nursing and Health Professions"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>25}, "Social Sciences"=>{"Social Sciences"=>10}, "Physics and Astronomy"=>{"Physics and Astronomy"=>3}, "Psychology"=>{"Psychology"=>2}, "Mathematics"=>{"Mathematics"=>3}, "Unspecified"=>{"Unspecified"=>7}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Engineering"=>{"Engineering"=>5}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>10}, "Computer Science"=>{"Computer Science"=>60}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Linguistics"=>{"Linguistics"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>3}, "Philosophy"=>{"Philosophy"=>1}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"Canada"=>1, "United States"=>2, "Ireland"=>1, "Finland"=>1, "United Kingdom"=>3, "Slovenia"=>1, "Switzerland"=>1, "Germany"=>3}, "group_count"=>17}

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  • {"files"=>["https://ndownloader.figshare.com/files/706318"], "description"=>"<p>Caterpillar plot of the individual mean and confidence intervals for health studies with overall mean proportion.</p>", "links"=>[], "tags"=>["computer science", "science policy", "Non-clinical medicine"], "article_id"=>376684, "categories"=>["Information And Computing Sciences", "Science Policy", "Medicine"], "users"=>["Khaled El Emam", "Elizabeth Jonker", "Luk Arbuckle", "Bradley Malin"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0028071.g003", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Caterpillar_plot_health_studies_/376684", "title"=>"Caterpillar plot (health studies).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-12-02 01:51:24"}
  • {"files"=>["https://ndownloader.figshare.com/files/706450"], "description"=>"<p>The number of new studies with success rates below/above the current mean that would need to be performed to significantly change the current mean for health studies.</p>", "links"=>[], "tags"=>["computer science", "science policy", "Non-clinical medicine"], "article_id"=>376809, "categories"=>["Information And Computing Sciences", "Science Policy", "Medicine"], "users"=>["Khaled El Emam", "Elizabeth Jonker", "Luk Arbuckle", "Bradley Malin"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0028071.g005", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Sensitivity_health_studies_/376809", "title"=>"Sensitivity (health studies).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-12-02 01:53:29"}
  • {"files"=>["https://ndownloader.figshare.com/files/706915"], "description"=>"<p>(§This is the first year that the report or article appears. Some of the reports we cite have been updated at later dates. Some reports describe re-identification attacks that may have occurred in earlier years. Since the appearance of the original results in 2010 a second article has been published more recently).</p>", "links"=>[], "tags"=>["re-identification", "attacks"], "article_id"=>377277, "categories"=>["Information And Computing Sciences", "Science Policy", "Medicine"], "users"=>["Khaled El Emam", "Elizabeth Jonker", "Luk Arbuckle", "Bradley Malin"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0028071.t002", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_A_summary_of_successful_re_identification_attacks_on_the_evaluation_criteria_/377277", "title"=>"A summary of successful re-identification attacks on the evaluation criteria.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-12-02 02:01:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/706955"], "description"=>"<p>The 18 elements in the HIPAA Privacy Rule Safe Harbor standard that must be removed or generalized for a data set to be considered de-identified (see 45 CFR 164.514(b)(2)(i)).</p>", "links"=>[], "tags"=>["18", "elements", "hipaa", "harbor", "removed", "generalized", "considered", "de-identified", "45", "cfr"], "article_id"=>377304, "categories"=>["Information And Computing Sciences", "Science Policy", "Medicine"], "users"=>["Khaled El Emam", "Elizabeth Jonker", "Luk Arbuckle", "Bradley Malin"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0028071.t001", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_18_elements_in_the_HIPAA_Privacy_Rule_Safe_Harbor_standard_that_must_be_removed_or_generalized_for_a_data_set_to_be_considered_de_identified_see_45_CFR_164_514_b_2_i_/377304", "title"=>"The 18 elements in the HIPAA Privacy Rule Safe Harbor standard that must be removed or generalized for a data set to be considered de-identified (see 45 CFR 164.514(b)(2)(i)).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-12-02 02:01:44"}
  • {"files"=>["https://ndownloader.figshare.com/files/706685"], "description"=>"<p>Funnel plot showing the proportion of records re-identified in health studies against standard error. The points were slightly jittered to reveal overlap.</p>", "links"=>[], "tags"=>["computer science", "science policy", "Non-clinical medicine"], "article_id"=>377046, "categories"=>["Information And Computing Sciences", "Science Policy", "Medicine"], "users"=>["Khaled El Emam", "Elizabeth Jonker", "Luk Arbuckle", "Bradley Malin"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0028071.g007", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Funnel_plot_health_studies_/377046", "title"=>"Funnel plot (health studies).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-12-02 01:57:26"}
  • {"files"=>["https://ndownloader.figshare.com/files/706174"], "description"=>"<p>PRISMA diagram summarizing the steps involved in the systematic review of the re-identification attack literature.</p>", "links"=>[], "tags"=>["computer science", "science policy", "Non-clinical medicine"], "article_id"=>376531, "categories"=>["Information And Computing Sciences", "Science Policy", "Medicine"], "users"=>["Khaled El Emam", "Elizabeth Jonker", "Luk Arbuckle", "Bradley Malin"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0028071.g001", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_PRISMA_diagram_/376531", "title"=>"PRISMA diagram.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-12-02 01:48:51"}
  • {"files"=>["https://ndownloader.figshare.com/files/706503"], "description"=>"<p>Funnel plot showing the proportion of records re-identified in all studies against standard error. The points were slightly jittered to reveal overlap.</p>", "links"=>[], "tags"=>["computer science", "science policy", "Non-clinical medicine"], "article_id"=>376865, "categories"=>["Information And Computing Sciences", "Science Policy", "Medicine"], "users"=>["Khaled El Emam", "Elizabeth Jonker", "Luk Arbuckle", "Bradley Malin"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0028071.g006", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Funnel_plot_all_studies_/376865", "title"=>"Funnel plot (all studies).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-12-02 01:54:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/358436"], "description"=>"<div><h3>Background</h3><p>Privacy legislation in most jurisdictions allows the disclosure of health data for secondary purposes without patient consent if it is de-identified. Some recent articles in the medical, legal, and computer science literature have argued that de-identification methods do not provide sufficient protection because they are easy to reverse. Should this be the case, it would have significant and important implications on how health information is disclosed, including: (a) potentially limiting its availability for secondary purposes such as research, and (b) resulting in more identifiable health information being disclosed. Our objectives in this systematic review were to: (a) characterize known re-identification attacks on health data and contrast that to re-identification attacks on other kinds of data, (b) compute the overall proportion of records that have been correctly re-identified in these attacks, and (c) assess whether these demonstrate weaknesses in current de-identification methods.</p> <h3>Methods and Findings</h3><p>Searches were conducted in IEEE Xplore, ACM Digital Library, and PubMed. After screening, fourteen eligible articles representing distinct attacks were identified. On average, approximately a quarter of the records were re-identified across all studies (0.26 with 95% CI 0.046–0.478) and 0.34 for attacks on health data (95% CI 0–0.744). There was considerable uncertainty around the proportions as evidenced by the wide confidence intervals, and the mean proportion of records re-identified was sensitive to unpublished studies. Two of fourteen attacks were performed with data that was de-identified using existing standards. Only one of these attacks was on health data, which resulted in a success rate of 0.00013.</p> <h3>Conclusions</h3><p>The current evidence shows a high re-identification rate but is dominated by small-scale studies on data that was not de-identified according to existing standards. This evidence is insufficient to draw conclusions about the efficacy of de-identification methods.</p> </div>", "links"=>[], "tags"=>["systematic", "re-identification", "attacks"], "article_id"=>130847, "categories"=>["Information And Computing Sciences", "Science Policy", "Medicine"], "users"=>["Khaled El Emam", "Elizabeth Jonker", "Luk Arbuckle", "Bradley Malin"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0028071", "stats"=>{"downloads"=>0, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/A_Systematic_Review_of_Re_Identification_Attacks_on_Health_Data/130847", "title"=>"A Systematic Review of Re-Identification Attacks on Health Data", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-12-02 00:14:07"}

PMC Usage Stats | Further Information

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Relative Metric

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