The ICD-10 codes between Z55 and Z65 are the social determinants
of health (SDOH) discharge codes. Social determinants of health
include factors like:
Neighborhood and physical environment
Social support networks
Access to health care
Addressing social determinants of health is important for
improving health and reducing longstanding disparities in health
and health care.
There is a large difference between the usage of the homelessness
code Z59.0 and all the other SDOH codes combined among emergency
department (ED) discharges. For that reason, we have split up the
analysis for Z59.0 versus all the others.
Use of the Homeless SDOH code (Z59.0):
Z59.0 (homelessness) was overwhelmingly the most used SDOH
code with 137,600 cases (1.1% of all ED discharges) in
318 of the 322 (98.8%) hospital EDs coded for homeless
(Z59.0) at least once in 2018.
Use of the Other SDOH codes (excluding
315 of the 322 (97.8%) EDs used at least one SDOH codes
during 2018 (up from 310 in 2017)
Only three EDs never used a SDOH code, during both 2017 and
28,304 ED discharges in 2018 (0.22% of 12,660,433) had at
least one SDOH code (up from 0.14% in 2017).
10,298 more ED discharges had at least one SDOH code in 2018
than in 2017 (28,304 vs. 18,006, a 157% increase).
3,772 ED discharges in 2018 (0.03%) had more than one SDOH
This represents 13.4% of all 2018 SDOH discharges, versus
8.92% in 2017.
Code Z60.2, Problems Related to Living Alone, was the
penultimate SDOH code used in 2018, coded on 5,111 ED discharges
Only one SDOH code was used zero times in 2018: Z63.71,
Stress on Family Due to Return of Family Member from Military
Four codes were used zero times in 2017, including
Emerging research suggests that SDOH codes could be valuable for
predicting patients with high readmission risk, as well as other
undesirable outcomes. Because of this, HQI encourages hospitals
to use SDOH codes as appropriate to improve the quality of data
available for this research.