USING SOCIAL DETERMINANTS OF HEALTH ICD-10 Z-CODES TO IDENTIFY NON-MEDICAL FACTORS AMONG ASTHMA HOSPITALIZATIONS IN THE UNITED STATES, 2016-2022
Author(s)
Nianyang Wang, PhD1, Huang Huang, PhD2, Jun Chu, PhD3, Joy Hsu, MD1;
1Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Augusta University, Augusta, GA, USA, 3University of Maryland Baltimore County, Baltimore, MD, USA
1Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Augusta University, Augusta, GA, USA, 3University of Maryland Baltimore County, Baltimore, MD, USA
OBJECTIVES: Asthma affects 25 million Americans and approximately 100,000 asthma-related hospitalizations occur annually. However, limited national-level data describe the social determinants of health (SDOH) that may relate to these hospitalizations. This study examines SDOH-related International Classification of Diseases, Tenth Revision (ICD-10) Z-codes in national administrative data on asthma hospitalizations and identifies characteristics associated with their documentation among asthma-related hospitalizations.
METHODS: Using 2016-2022 National Inpatient Sample data, we conducted weighted descriptive statistics for 200,452 U.S. hospitalizations (pediatric and adult) with a primary asthma diagnosis (ICD-10 code J45). Weighted univariable and multivariable logistic regression estimated associations between SDOH Z-code documentation (ICD-10 codes Z55-Z65) and seven selected variables: age, sex, race/ethnicity, primary payer, estimated household income quartile (zip code - level), hospital region, and hospital type (urban teaching, urban non-teaching, or rural). We calculated unadjusted and adjusted odds ratios (ORs and aORs) and 95% confidence intervals (CIs).
RESULTS: In unweighted analyses, 3,149 asthma hospitalizations had ≥ 1 SDOH Z-code (1.57%). The most frequently documented were homelessness (Z59.0; n=942) and unemployment (Z56.0; n=349). Weighted chi-squared analyses demonstrated all seven variables were associated with asthma hospitalization SDOH Z-code documentation. Logistic regression results varied by demographic and hospital characteristics. For example, adjusted odds for asthma hospitalizations were lower for patients aged 0-17 years (aOR=0.32 [95%CI:0.28-0.37]) and 75+ years (aOR=0.48 [95%CI:0.38-0.61]) compared to adults aged 18-34 years, while those aged 35-44 years had higher odds (aORs 1.19 (95%CI:1.06-1.35). Asthma hospitalizations at rural hospitals had lower odds SDOH Z-code documentation (OR:0.57, 95%CI:0.47-0.70) compared to urban teaching hospitals.
CONCLUSIONS: Nationally representative 2016-2022 data show that housing- and employment-related Z-codes were the most commonly documented SDOH among asthma hospitalizations. Future research exploring causality could assist public health practitioners to better understand, interpret, and use SDOH Z-codes to refine asthma prevention and control strategies.
METHODS: Using 2016-2022 National Inpatient Sample data, we conducted weighted descriptive statistics for 200,452 U.S. hospitalizations (pediatric and adult) with a primary asthma diagnosis (ICD-10 code J45). Weighted univariable and multivariable logistic regression estimated associations between SDOH Z-code documentation (ICD-10 codes Z55-Z65) and seven selected variables: age, sex, race/ethnicity, primary payer, estimated household income quartile (zip code - level), hospital region, and hospital type (urban teaching, urban non-teaching, or rural). We calculated unadjusted and adjusted odds ratios (ORs and aORs) and 95% confidence intervals (CIs).
RESULTS: In unweighted analyses, 3,149 asthma hospitalizations had ≥ 1 SDOH Z-code (1.57%). The most frequently documented were homelessness (Z59.0; n=942) and unemployment (Z56.0; n=349). Weighted chi-squared analyses demonstrated all seven variables were associated with asthma hospitalization SDOH Z-code documentation. Logistic regression results varied by demographic and hospital characteristics. For example, adjusted odds for asthma hospitalizations were lower for patients aged 0-17 years (aOR=0.32 [95%CI:0.28-0.37]) and 75+ years (aOR=0.48 [95%CI:0.38-0.61]) compared to adults aged 18-34 years, while those aged 35-44 years had higher odds (aORs 1.19 (95%CI:1.06-1.35). Asthma hospitalizations at rural hospitals had lower odds SDOH Z-code documentation (OR:0.57, 95%CI:0.47-0.70) compared to urban teaching hospitals.
CONCLUSIONS: Nationally representative 2016-2022 data show that housing- and employment-related Z-codes were the most commonly documented SDOH among asthma hospitalizations. Future research exploring causality could assist public health practitioners to better understand, interpret, and use SDOH Z-codes to refine asthma prevention and control strategies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD121
Topic
Health Service Delivery & Process of Care
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)