508 Temporal Trends in Use of Social Determinants of Health Diagnoses in Emergency Department Patients

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

Ann Emerg Med

Abstract

Study Objective: Social determinants of health (SDoH) significantly impact patient outcomes. Recently, there has been a growing focus on identifying SDoH to enhance patient access to resources and improve the efficiency of healthcare systems. One method of capturing SDoH is using ICD-10 codes (Z55-65), introduced in 2015. These codes address issues related to education and literacy, employment, housing, economic stability, and psychosocial circumstances. We hypothesize that two recent significant events may have led to increased documentation of these ICD-10 codes: the passage of California Senate Bill 1152 in 2019, which requires addressing SDoH before discharging the patient from the hospital, and changes to billing and coding guidelines in 2023 that recognize SDoH as a factor in determining the complexity of medical decision-making. Methods: The California Health & Human Services Agency makes ICD-10 codes for all emergency department visits publicly available. To analyze the frequency of Social Determinants of Health (SDoH) diagnoses, we calculated the rate per 100,000 total diagnoses (dx/100k) annually. We divided the years into three periods based on significant events: 2016-2018, 2019-2022, and 2023. We employed a two-way ANOVA to compare the average frequency of SDoH diagnoses across these periods and ICD-10 groupings. We evaluated the differences between individual groups using Post-hoc Tukey HSD testing. A P-value of less than 0.05 was considered statistically significant. Results: Overall, there were statistically significant differences in the rates of Social Determinants of Health (SDoH) diagnoses across different periods (p <0.001 for 2016-2018 vs 2019-2022; p=0.047 for 2019-2022 vs 2023; p <0.001 for 2016-2018 vs 2023) and in terms of ICD-10 grouping (p <0.001). The SDoH category that exhibited the most significant increase in the relative rate of diagnoses when comparing 2023 to 2016 was “problems related to education and literacy” (Z55), which increased from 0.45 to 25.3 diagnoses per 100,000 people, representing a rate of 55.8. In 2023, the most frequently diagnosed SDoH were “problems related to housing/economic circumstances” (Z59) at 522.6 diagnoses per 100,000, followed by “employment/unemployment” (Z56) at 98.4, and “other psychosocial circumstances” (Z65) at 83.7 diagnoses per 100,000, respectively. Conclusions: The use of Social Determinants of Health (SDoH) diagnosis codes in California emergency departments has significantly increased. Further research is necessary to determine whether these trends exist in other settings. No, authors do not have interests to disclose

Volume

86

Issue

3

First Page

S216

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