Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016–2017
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BACKGROUND: The inclusion of Z-codes for social determinants of health (SDOH) in the 10th revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level. OBJECTIVE: To examine the prevalence of SDOH Z-codes and compare characteristics of patients with and without Z-codes and hospitals that do and do not use Z-codes. RESEARCH DESIGN: Retrospective cohort study using 2016 and 2017 National Inpatient Sample. PARTICIPANTS: Total of 14,289,644 inpatient hospitalizations. MEASURES: Prevalence of SDOH Z-codes (codes Z55-Z65) and descriptive statistics of patients and hospitals. RESULTS: Of admissions, 269,929 (1.9%) included SDOH Z-codes. Average monthly SDOH Z-code use increased across the study period by 0.01% per month (P<0.001). The cumulative number and proportion of hospitals that had ever used an SDOH Z-code also increased, from 1895 hospitals (41%) in January 2016 to 3210 hospitals (70%) in December 2017. Hospitals that coded at least 1 SDOH Z-code were larger, private not-for-profit, and urban teaching hospitals. Compared with admissions without an SDOH Z-code, admissions with them were for patients who were younger, more often male, Medicaid recipients or uninsured. A higher proportion of admissions with SDOH Z-codes were for mental health (44.0% vs. 3.3%, P<0.001) and alcohol and substance use disorders (9.6% vs. 1.1%, P<0.001) compared with those without. CONCLUSIONS: The uptake of SDOH Z-codes has been slow, and current coding is likely poorly reflective of the actual burden of social needs experienced by hospitalized patients
Diagnosis code · Environmental health · Family medicine · Health care · Medicaid · Political science · Population · Public health · Social determinants of health · Sociology · Chronic Disease Management Strategies · Demography · Food Security and Health in Diverse Populations · Law · Medical Coding and Health Information · Medicine · Nursing
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