What Do We Know about Utilization of Z Codes in the Pediatric Population? Exploring Variation in Z Code Use and Social Determinants of Health in a U.S. Hospital-Based, All-Payer Database

OBJECTIVES: Social determinants of health (SDoH) are important nonmedical factors that can impact health outcomes. Despite the availability of Z codes to document SDoH, their use during patient encounters is very low, but can improve delivery of health care. There is a paucity of research on utilization of Z codes and only a handful of these studies have been conducted in the pediatric population (age <18 years). This study documented Z code use and examined the association between patient, clinical, and hospital characteristics and SDoH domains within a pediatric population.

METHODS: A descriptive analysis using a hospital-based, service level, all-payer, administrative database was conducted to examine Z code diagnoses among pediatric patients discharged from 1,023 U.S. hospitals with an index visit between January 2016 and December 2021. All data were statistically de-identified and compliant with HIPAA. Descriptive statistics and adjusted analyses were used to document differences across factors and their association with ten SDoH domains.

RESULTS: Only 1.4% (n=360,706) of pediatric patients had evidence of any Z code. Compared to the pediatric population without Z codes (n=24,588,782), patients with evidence of Z codes were significantly more likely (all χ² p values < 0.0001) to be female (55% vs 49%), between the ages of 12-17 (52% vs 28%), African American (21% vs 16%), and to be on Medicaid (65% vs 50%). The top three Z codes were dietary counseling and surveillance (n=110,542), other problems related to lifestyle (n=56,672), and other specific counseling (n=48,441). In the adjusted analysis, virtually all predictors were significantly associated with each of the SDoH domains to varying degrees, but most notably age, race, ethnicity, and payor type.

CONCLUSIONS: Because socioeconomic factors, physical environment, and health behaviors drive 80% of health outcomes, it is important to continue to encourage adoption of Z codes by clinicians across healthcare settings.