CoChat
Sign Up
Cited by 16Medical Coding and Health InformationHealth disparities and outcomesHealthcare Policy and Management

Social Needs Identified by Diagnostic Codes in Privately Insured U.S. Adults

Open access
Liss, David T., Cherupally, Manisha, Kang, Raymond H., Aikman, Cassandra, Cooper, Andrew J., O'Brien, Matthew J.·2022·American Journal of Preventive Medicine
DOI 10.1016/j.amepre.2022.07.009PMC PMC10286127
Open this paper in CoChat — free accountOpen PDF

Abstract

Introduction The relationships between healthcare use and social needs are not fully understood. In 2015, International Classification of Diseases, Tenth Revision coding introduced voluntary Z codes for social needs‒related healthcare encounters. This study evaluated early national patterns of Z codes in privately insured adults. Methods In 2021, the authors conducted a case-control analysis of national commercial health payer claims from 2016 to 2019. Among adults with ≥6 months of continuous enrollment and ≥1 medical claims, patients with any assigned Z codes were defined as cases. Controls were selected through stratified random sampling. Z codes were organized under 3 categories: socioeconomic, community/social, and environmental. Results Of 29.5 million adults, 521,334 patients (1.8%) had any assigned Z codes. Among all the Z codes, 53.5% identified community/social issues, 30.3% identified environmental issues, and 16.2% identified socioeconomic issues. Among socioeconomic Z codes, housing needs were frequently identified, but needs for food, utility bills, and transportation were very rarely identified. In multivariable regression analysis, females had higher odds of Z code assignment than males. Depression and chronic pulmonary disease were the 2 common comorbidities (≥5% prevalence in cases and controls) that were highly associated with Z code assignment. Less common comorbidities strongly associated with Z code assignment were drug abuse, alcohol abuse, psychoses, and AIDS/HIV. Conclusions In this national study of privately insured patients, many Z codes identified healthcare encounters caused by social stressors, whereas few identified food- or transportation-related causes. Depression and chronic pulmonary disease were highly associated with Z code assignment.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.amepre.2022.07.009

Cites

5 of 5 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • ICD-10-CM Z codes (Z55-Z65) are typically under-coded in individuals' health records.

    “are typically under-coded in individuals’ health records”

    From Documentation of individual-level social determinants of health among adults diagnosed with cancer in the United States (2025) · cites this paper as [15]

    The Discussion’s Limitations section says voluntary Z-code assignment likely led to substantial underdocumentation of social needs, supporting the claim’s central point. But the study examined privately insured U.S. adults during a four-year period ending in 2019, and the authors caution that its documentation patterns may not generalize to people with other insurance or no insurance. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Available studies using Medicare and private insurance claims data reported that about 1 in 1,000 claims included Z codes.

    “Available studies using Medicare and private insurance claims data reported that about 1 in 1,000 claims included Z codes14,15.”

    From Documentation of individual-level social determinants of health among adults diagnosed with cancer in the United States (2025) · cites this paper as [15]

    The Methods describe a study using private-insurance claims, and the Introduction discusses prior Medicare Z-code studies. But the Results report that 521,334 of 29.5 million adults (1.8%) had a Z code—a proportion of patients, not the claimed roughly 1 in 1,000 claims. Our copy does not report that claims-level figure. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Another study found that 1.8% of 29.5 million adults enrolled in private insurance had documented SDOH Z codes between 2016 and 2019.

    “Similarly, another study found that 1.8% of 29.5 million adults enrolled in private insurance had documented SDOH Z codes between 2016 and 201915.”

    From Documentation of individual-level social determinants of health among adults diagnosed with cancer in the United States (2025) · cites this paper as [15]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 17

  1. [1]Marmot M, Bell R. Fair society, healthy lives. Public Health. 2012; 126 (suppl 1): S4– S10. 10.1016/j.puhe.2012.05.014. 22784581 · DOI
  2. [2]Kondo N Socioeconomic disparities and health: impacts and pathways. J Epidemiol. 2012; 22(1): 2– 6. 10.2188/jea.JE20110116. 22156290 PMC3798573 · DOI
  3. [3]Schroeder SA, Lecture S. We can do better–improving the health of the American people. N Engl J Med. 2007; 357(12): 1221– 1228. 10.1056/NEJMsa073350. 17881753 · DOI · Paper page
  4. [4]Giovanatti A, Elassar H, Karabon P, Wunderlich-Barillas T, Halalau A. Social determinants of health correlating with mechanical ventilation of COVID-19 patients: a multi-center observational study. Int J Gen Med. 2021; 14: 8521– 8526. 10.2147/IJGM.S334593. 34848998 PMC8612671 · DOI
  5. [5]Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med. 2020; 8(7): 659– 661. 10.1016/S2213-2600(20)30234-4. 32437646 PMC7234789 · DOI
  6. [7]Alderwick H, Gottlieb LM. Meanings and misunderstandings: a social determinants of health lexicon for healthcare systems. Milbank Q. 2019; 97(2): 407– 419. 10.1111/1468-0009.12390. 31069864 PMC6554506 · DOI · Paper page
  7. [11]Gottlieb LM, Wing H, Adler NE. A systematic review of interventions on patients’ social and economic needs. Am J Prev Med. 2017; 53(5): 719– 729. 10.1016/j.amepre.2017.05.011. 28688725 · DOI · Paper page
  8. [12]Torres J, De Marchis E, Fichtenberg C, Gottlieb L. Identifying food insecurity in healthcare settings: a review of the evidence. San Francisco, CA: Social Interventions Research & Evaluation Network; 2017. https://pubmed.ncbi.nlm.nih.gov/30431466/. Accessed August 23, 2022.
  9. [14]Torres JM, Lawlor J, Colvin JD, ICD social codes: an underutilized resource for tracking social needs. Med Care. 2017; 55(9): 810– 816. 10.1097/MLR.0000000000000764. 28671930 · DOI · Paper page
  10. [16]American Medical Association. CPT® evaluation and management (E/M) office or other outpatient (99202–99215) and prolonged services (99354:99355, 99356, 99417) code and guideline changes. Chicago, IL: American Medical Association; January 1, 2021. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf. Accessed August 23, 2022.
  11. [17]Weeks WB, Cao SY, Lester CM, Weinstein JN, Morden NE. Use of Z codes to record social determinants of health among fee-for-service Medicare beneficiaries in 2017. J Gen Intern Med. 2020; 35(3): 952– 955. 10.1007/s11606-019-05199-w. 31325129 PMC7080897 · DOI · Paper page
  12. [21]Bensken WP, Alberti PM, Koroukian SM. Health-related social needs and increased readmission rates: findings from the nationwide readmissions database. J Gen Intern Med. 2021; 36(5): 1173– 1180. 10.1007/s11606-021-06646-3. 33634384 PMC8131460 · DOI
  13. [23]Carter J, Ward C, Thorndike A, Donelan K, Wexler DJ. Social factors and patient perceptions associated with preventable hospital readmissions. J Patient Exp. 2020; 7(1): 19– 26. 10.1177/2374373518825143. 32128367 PMC7036679 · DOI
  14. [25]Ackermann RT, Wallia A, O’Brien MJ, Correlates of second-line type 2 diabetes medication selection in the USA. BMJ Open Diabetes Res Care. 2017; 5(1): e000421. 10.1136/bmjdrc-2017-000421. PMC5706487 29225892 · DOI
  15. [27]O’Brien MJ, Karam SL, Wallia A, Association of second-line antidiabetic medications with cardiovascular events among insured adults with type 2 diabetes. JAMA Netw Open. 2018; 1(8): e186125. 10.1001/jamanetworkopen.2018.6125. 30646315 PMC6324353 · DOI
  16. [28]Wallia A, O’Brien MJ, Liss DT, Glycemic outcomes of second-line diabetes drug choice in a real-world population. Mayo Clin Proc Innov Qual Outcomes. 2021; 5(3): 675– 681. 10.1016/j.mayocpiqo.2021.02.008. 34195559 PMC8240148 · DOI
  17. [35]Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998; 36(1): 8– 27. 10.1097/00005650-199801000-00004. 9431328 · DOI · Paper page

Cited by

Sorted by citations

Authors
Liss, D. T., Cherupally, M., Kang, R. H., Aikman, C., Cooper, A. J., & O'Brien, M. J.
Affiliations
Northwestern University (US)
Corresponding author
Liss, David T.
ORCID
Venue
American Journal of Preventive Medicine
Publisher
Elsevier BV
Published
2022-12
Volume
63
Issue
6
Pages
1007-1016
ISSN
0749-3797 (ISSN-L)
DOI
10.1016/j.amepre.2022.07.009
PMC
PMC10286127
OpenAlex
W4294204395
Cited by
16
References
5
Citations by year
2026: 2 · 2025: 6 · 2024: 4 · 2023: 4
FWCI
2.62
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Health and Human Services (1HP29963)
  • Health Resources and Services Administration
  • UnitedHealth Group Inc
Topics
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
social needs, Z codes, ICD-10, privately insured adults, commercial health insurance claims, housing needs, socio-economic needs, environmental requirements, depression, chronic lung disease, comorbidities, health care utilization, social stressors
MeSH terms
Adult, Alcoholism, Female, Food, Humans, Insurance, Health, Male, Research Design, Case-Control Studies

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review