OBJECTIVES: In addition to traditional concepts of health and disease, social determinants of health (SDOH) play a critical role in patient well-being. The International Classification of Diseases, 10^th Edition (ICD-10) includes codes Z55-Z65, which describe problems related to family life, ability, living and working environments, and psychosocial well-being. The present study aims to assess which ICD-10 codes are utilized in Swedish administrative data, how often, and in which populations.

METHODS: Anonymized data was extracted from the Swedish National Board of Health and Welfare from all patients presenting at an in-patient or specialized out-patient clinic during 2016-2020 with a registered SDOH ICD-10 diagnosis code (Z55-Z65). The number of diagnoses registered annually for each ICD code (with precision to three characters) were extracted together with patients’ age, sex, and type of care contact (in- or out-patient).

RESULTS: In 2020, a total of 19 145 patients received an out-patient SDOH diagnosis, of which 96% were female. The corresponding number for in-patient care was 514 patients, with 52% females. The most frequently registered in-patient diagnosis was Z60 (problems related to social environment) at an average rate of 4 patients/100 000 population annually, balanced between males and females, but much more prevalent in the elderly. The most frequent out-patient diagnosis was Z64 (problems related to certain psychosocial circumstances) at an average rate of 200 patients/100 000 population annually, predominantly in women, most commonly between ages 15-44. A variety of codes were unevenly distributed between age groups, such as Z55 (problems related to education and literacy), which was more common among children and elderly.

CONCLUSIONS: SDOH are important to patient well-being and should be registered within the ICD system in Sweden. Swedish administrative data show major differences between the registration of SDOH diagnoses in in- and out-patient care, between males and females, and between age groups.