Using Z Codes to Characterize Health and Social Histories in Commercially Insured Non-Hodgkin Lymphoma Patients: Insights from Real-World Data
Author(s)
Godwin Okoye, BPharm, MS, Anton L. Avanceña, MS, PhD;
Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
OBJECTIVES: Social and health-related factors, such as socioeconomic status and smoking history, influence cancer outcomes, including survival and mortality. Z codes, introduced in 2015 within the ICD-10-CM system, document patient histories and exposures. These codes offer insights into determinants of health that impact care and outcomes. However, the extent of Z code documentation in oncology remains unclear. Using Non-Hodgkin Lymphoma (NHL) patients as a case study, this study aimed to examine Z code documentation and patient characteristics among NHL patients.
METHODS: We conducted a retrospective analysis of Merative MarketScan® claims database to identify patients with ≥1 inpatient diagnosis or ≥2 outpatient diagnoses of NHL and any Z code claim between January 1, 2016, and December 31, 2021. We determined the distribution of documented Z codes by category (e.g., economic, housing, lifestyle behaviors) and by the NHL subtype. Patient demographics, including age, sex, and insurance type, were summarized using descriptive statistics.
RESULTS: Among NHL patients (N=129,090), only 4.16% (N=5,366) had documented Z code. The most prevalent NHL subtypes within this cohort were diffuse large B-cell lymphoma (DLBCL-34.74%), chronic lymphocytic leukemia of the B-cell type (CLLBCT-27.67%), and follicular lymphoma (FL-26.63%). Lifestyle-related factors, such as alcohol and tobacco use, physical inactivity, and receipt of health services due to lifestyle, represented 94.93% of documented Z codes. Patients were predominantly male (58.4%) with a mean age of 59.6 years, and 51.6% were covered by a preferred provider organization insurance plan.
CONCLUSIONS: Z code documentation in NHL patients was limited but provided valuable insights into social and behavioral health factors influencing care. The dominance of lifestyle-related codes underscores the need for targeted strategies to address behavioral health concerns and reduce disparities in NHL outcomes. Expanding Z code usage may enhance comprehensive care delivery in oncology settings, particularly among NHL patients.
METHODS: We conducted a retrospective analysis of Merative MarketScan® claims database to identify patients with ≥1 inpatient diagnosis or ≥2 outpatient diagnoses of NHL and any Z code claim between January 1, 2016, and December 31, 2021. We determined the distribution of documented Z codes by category (e.g., economic, housing, lifestyle behaviors) and by the NHL subtype. Patient demographics, including age, sex, and insurance type, were summarized using descriptive statistics.
RESULTS: Among NHL patients (N=129,090), only 4.16% (N=5,366) had documented Z code. The most prevalent NHL subtypes within this cohort were diffuse large B-cell lymphoma (DLBCL-34.74%), chronic lymphocytic leukemia of the B-cell type (CLLBCT-27.67%), and follicular lymphoma (FL-26.63%). Lifestyle-related factors, such as alcohol and tobacco use, physical inactivity, and receipt of health services due to lifestyle, represented 94.93% of documented Z codes. Patients were predominantly male (58.4%) with a mean age of 59.6 years, and 51.6% were covered by a preferred provider organization insurance plan.
CONCLUSIONS: Z code documentation in NHL patients was limited but provided valuable insights into social and behavioral health factors influencing care. The dominance of lifestyle-related codes underscores the need for targeted strategies to address behavioral health concerns and reduce disparities in NHL outcomes. Expanding Z code usage may enhance comprehensive care delivery in oncology settings, particularly among NHL patients.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P31
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology