Documentation of individual-level social determinants of health among adults diagnosed with cancer in the United States

The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in individuals’ health records. There is limited characterization of SDOH Z codes among adults diagnosed with cancer and information about oncol...

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Vydáno v:	Scientific reports Ročník 15; číslo 1; s. 29646 - 11
Hlavní autoři:	Hsu, Chia-Yun, Henderson, Gabriel, Slejko, Julia F., Hussain, Arif, Swain, Richard Scott, Kalesan, Bindu, Huang, Pei-Lin, Onukwugha, Eberechukwu
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London Nature Publishing Group UK 13.08.2025 Nature Publishing Group Nature Portfolio
Témata:	692/4028/67 692/4028/67/2324 692/499 Adult Aged Beneficiaries Cancer Claims data Codes Comorbidity Cross-Sectional Studies Documentation Electronic health records Female Health care expenditures Humanities and Social Sciences Humans International Classification of Diseases Male Mammography Medicaid Medicare Metastases Metastasis Middle Aged multidisciplinary Neoplasms - diagnosis Neoplasms - epidemiology Oncology Patients Physician perspectives Registries Science Science (multidisciplinary) Social determinants of health Social Determinants of Health - statistics & numerical data Socioeconomic factors United States - epidemiology Z codes United States United States > US Social determinants of health Z codes Claims data Physician perspectives
ISSN:	2045-2322, 2045-2322
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Abstract	The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in individuals’ health records. There is limited characterization of SDOH Z codes among adults diagnosed with cancer and information about oncologists’ perspectives on Z codes. Using pooled cross sections, we selected 35,099 adults from the IQVIA PharMetrics ® Plus for Academics data and 17,852 individuals from linked cancer registry and claims data. The prevalence of comorbidities and metastatic cancer was higher among individuals with Z codes compared to those without Z code claims. The proportion of individuals with any Z code claims ranged from 0.6 to 0.9% in the PharMetrics Plus data and from 1.4 to 2.1% in the linked data. Among 112 medical oncologists/hematologists who responded to a survey about SDOH Z codes, 54% had not heard of Z codes to document SDOH. 26% reported that lack of reimbursement makes it difficult to increase their documentation and 64% would consider using Z codes if they are tied to payer reimbursement. Individuals with Z codes had greater comorbidity and cancer burden. Additional research is needed and depends on improved coding of SDOH Z codes.
AbstractList	Abstract The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in individuals’ health records. There is limited characterization of SDOH Z codes among adults diagnosed with cancer and information about oncologists’ perspectives on Z codes. Using pooled cross sections, we selected 35,099 adults from the IQVIA PharMetrics® Plus for Academics data and 17,852 individuals from linked cancer registry and claims data. The prevalence of comorbidities and metastatic cancer was higher among individuals with Z codes compared to those without Z code claims. The proportion of individuals with any Z code claims ranged from 0.6 to 0.9% in the PharMetrics Plus data and from 1.4 to 2.1% in the linked data. Among 112 medical oncologists/hematologists who responded to a survey about SDOH Z codes, 54% had not heard of Z codes to document SDOH. 26% reported that lack of reimbursement makes it difficult to increase their documentation and 64% would consider using Z codes if they are tied to payer reimbursement. Individuals with Z codes had greater comorbidity and cancer burden. Additional research is needed and depends on improved coding of SDOH Z codes. The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in individuals' health records. There is limited characterization of SDOH Z codes among adults diagnosed with cancer and information about oncologists' perspectives on Z codes. Using pooled cross sections, we selected 35,099 adults from the IQVIA PharMetrics Plus for Academics data and 17,852 individuals from linked cancer registry and claims data. The prevalence of comorbidities and metastatic cancer was higher among individuals with Z codes compared to those without Z code claims. The proportion of individuals with any Z code claims ranged from 0.6 to 0.9% in the PharMetrics Plus data and from 1.4 to 2.1% in the linked data. Among 112 medical oncologists/hematologists who responded to a survey about SDOH Z codes, 54% had not heard of Z codes to document SDOH. 26% reported that lack of reimbursement makes it difficult to increase their documentation and 64% would consider using Z codes if they are tied to payer reimbursement. Individuals with Z codes had greater comorbidity and cancer burden. Additional research is needed and depends on improved coding of SDOH Z codes. The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in individuals' health records. There is limited characterization of SDOH Z codes among adults diagnosed with cancer and information about oncologists' perspectives on Z codes. Using pooled cross sections, we selected 35,099 adults from the IQVIA PharMetrics® Plus for Academics data and 17,852 individuals from linked cancer registry and claims data. The prevalence of comorbidities and metastatic cancer was higher among individuals with Z codes compared to those without Z code claims. The proportion of individuals with any Z code claims ranged from 0.6 to 0.9% in the PharMetrics Plus data and from 1.4 to 2.1% in the linked data. Among 112 medical oncologists/hematologists who responded to a survey about SDOH Z codes, 54% had not heard of Z codes to document SDOH. 26% reported that lack of reimbursement makes it difficult to increase their documentation and 64% would consider using Z codes if they are tied to payer reimbursement. Individuals with Z codes had greater comorbidity and cancer burden. Additional research is needed and depends on improved coding of SDOH Z codes.The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in individuals' health records. There is limited characterization of SDOH Z codes among adults diagnosed with cancer and information about oncologists' perspectives on Z codes. Using pooled cross sections, we selected 35,099 adults from the IQVIA PharMetrics® Plus for Academics data and 17,852 individuals from linked cancer registry and claims data. The prevalence of comorbidities and metastatic cancer was higher among individuals with Z codes compared to those without Z code claims. The proportion of individuals with any Z code claims ranged from 0.6 to 0.9% in the PharMetrics Plus data and from 1.4 to 2.1% in the linked data. Among 112 medical oncologists/hematologists who responded to a survey about SDOH Z codes, 54% had not heard of Z codes to document SDOH. 26% reported that lack of reimbursement makes it difficult to increase their documentation and 64% would consider using Z codes if they are tied to payer reimbursement. Individuals with Z codes had greater comorbidity and cancer burden. Additional research is needed and depends on improved coding of SDOH Z codes. The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in individuals’ health records. There is limited characterization of SDOH Z codes among adults diagnosed with cancer and information about oncologists’ perspectives on Z codes. Using pooled cross sections, we selected 35,099 adults from the IQVIA PharMetrics® Plus for Academics data and 17,852 individuals from linked cancer registry and claims data. The prevalence of comorbidities and metastatic cancer was higher among individuals with Z codes compared to those without Z code claims. The proportion of individuals with any Z code claims ranged from 0.6 to 0.9% in the PharMetrics Plus data and from 1.4 to 2.1% in the linked data. Among 112 medical oncologists/hematologists who responded to a survey about SDOH Z codes, 54% had not heard of Z codes to document SDOH. 26% reported that lack of reimbursement makes it difficult to increase their documentation and 64% would consider using Z codes if they are tied to payer reimbursement. Individuals with Z codes had greater comorbidity and cancer burden. Additional research is needed and depends on improved coding of SDOH Z codes. The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in individuals’ health records. There is limited characterization of SDOH Z codes among adults diagnosed with cancer and information about oncologists’ perspectives on Z codes. Using pooled cross sections, we selected 35,099 adults from the IQVIA PharMetrics ® Plus for Academics data and 17,852 individuals from linked cancer registry and claims data. The prevalence of comorbidities and metastatic cancer was higher among individuals with Z codes compared to those without Z code claims. The proportion of individuals with any Z code claims ranged from 0.6 to 0.9% in the PharMetrics Plus data and from 1.4 to 2.1% in the linked data. Among 112 medical oncologists/hematologists who responded to a survey about SDOH Z codes, 54% had not heard of Z codes to document SDOH. 26% reported that lack of reimbursement makes it difficult to increase their documentation and 64% would consider using Z codes if they are tied to payer reimbursement. Individuals with Z codes had greater comorbidity and cancer burden. Additional research is needed and depends on improved coding of SDOH Z codes.
ArticleNumber	29646
Author	Henderson, Gabriel Huang, Pei-Lin Onukwugha, Eberechukwu Slejko, Julia F. Swain, Richard Scott Hussain, Arif Hsu, Chia-Yun Kalesan, Bindu
Author_xml	– sequence: 1 givenname: Chia-Yun surname: Hsu fullname: Hsu, Chia-Yun organization: Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland – sequence: 2 givenname: Gabriel surname: Henderson fullname: Henderson, Gabriel organization: Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland – sequence: 3 givenname: Julia F. surname: Slejko fullname: Slejko, Julia F. organization: Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland, Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center – sequence: 4 givenname: Arif surname: Hussain fullname: Hussain, Arif organization: Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, Department of Medicine, School of Medicine, University of Maryland, Baltimore Veterans Affairs Medical Center – sequence: 5 givenname: Richard Scott surname: Swain fullname: Swain, Richard Scott organization: Cardinal Health Inc., & Engagement, Real-World Evidence & Insights – sequence: 6 givenname: Bindu surname: Kalesan fullname: Kalesan, Bindu organization: Cardinal Health Inc., & Engagement, Real-World Evidence & Insights – sequence: 7 givenname: Pei-Lin surname: Huang fullname: Huang, Pei-Lin organization: Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland – sequence: 8 givenname: Eberechukwu surname: Onukwugha fullname: Onukwugha, Eberechukwu email: eonukwug@rx.umaryland.edu organization: Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland, Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center
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Cites_doi	10.1007/s11606-019-05199-w 10.1001/jamanetworkopen.2023.12538 10.3934/publichealth.2019.3.209 10.1377/hlthaff.2016.0723 10.3322/caac.21820 10.1200/jco.2017.74.2049 10.1097/md.0000000000023818 10.1097/jxx.0000000000000586 10.1055/s-0038-1667081 10.3322/caac.21708 10.1001/jamanetworkopen.2022.22009 10.1111/1475-6773.14039 10.1093/jnci/djw205 10.1002/cam4.1322 10.1089/pop.2018.0151 10.1016/j.amepre.2021.10.004 10.1016/j.amjsurg.2022.06.012 10.3322/caac.21586 10.1016/j.focus.2023.100089 10.18865/ed.31.3.433 10.1038/s41416-020-01038-6 10.1097/01.mlr.0000223480.52713.b9 10.1016/j.amepre.2022.07.009 10.2196/54732 10.1097/mlr.0000000000001418 10.1093/jamiaopen/ooy051
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Snippet	The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically under-coded in... Abstract The ICD-10-CM diagnosis codes ranging from Z55 to Z65 (Z codes) capture individual-level social determinants of health (SDOH) and are typically...
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Title	Documentation of individual-level social determinants of health among adults diagnosed with cancer in the United States
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Volume	15
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