Disparities in the Documentation of Social Determinants of Health ICD-10 Z-codes for Patients Diagnosed with Cancer: An Epic Cosmos Study

Poster Number: P70
Presentation Time: 05:00 PM - 06:30 PM

Abstract Keywords: Health Equity, Racial Disparities, Population Health, Personal Health Informatics, Diversity, Equity, Inclusion, Accessibility, and Health Equity, Data Mining, Data Sharing, Information Visualization
Primary Track: Applications
Programmatic Theme: Clinical Informatics

Understanding social determinants of health (SDOH) is crucial for effective cancer care. To better understand the utilization of SDOH ICD-10 Z-codes, we created a cohort of 182,183,658 individuals who are 18 years or older and have at least one clinical visit between 2014 and 2023 in the multi-institution HIPAA-limited Epic Cosmos database. We found that patients with cancer have disproportionately higher rates of SDOH documentation compared with patients without cancer, especially in problems with (a) Z57-Occupational exposure, (b) Z60-Social environment, (c) Z72-Lifestyle, and (d) Z75-Medical facilities. Our analysis reveals that patients with cancer who identified as Black or African American and American Indian or Alaskan Native have the highest rate of Z-codes documentation (10.2% and 11.3%, respectively), and the two groups also had the highest percentage increase over the 10 years. In addition, individuals who are more socially vulnerable (based on the social vulnerability index) are more often documented with SDOH (17.5% for high risk vs. 10.7% for low risk). We observed an increasing trend of Z-codes documentation among patients with cancer, which underscores the heightened awareness of SDOH as well as the growing utilization of associated Z-codes. It suggests an optimistic future where SDOH factors will be better addressed in cancer care. However, the overall Z-code utilization is still low. Marked social disparities (based on documented SDOH Z-codes) exist for cancer patients and individuals in disadvantaged ethnic and social subgroups. These disparities call for more focused approaches to study root causes and promote equity in cancer care.

Speaker(s):
Yiming Zhang, M.D.
UMass Chan Medical School

Author(s):
Yiming Zhang, M.D. - UMass Chan Medical School; Charlotte DeLeo, MD, MPH - UMass Chan Medical School; Mara Epstein, ScD, ScM - UMass Chan Medical School; Sarah Cutrona, MD, MPH - University of Massachusetts Medical School; Huanmei Wu, FAMIA, PhD - Temple University; Ben Gerber, MD, MPH - University of Massachusetts Chan Medical School; Eric Alper, MD - UMass Memorial Health Care; Feifan Liu, PhD - University of Massachusetts Chan Medical School;