Lee Jun Soo, MacLeod Kara E, Kuklina Elena V, Tong Xin, Jackson Sandra L
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
ASRT, Inc., Atlanta, Georgia.
AJPM Focus. 2023 Mar 3;2(2):100089. doi: 10.1016/j.focus.2023.100089. eCollection 2023 Jun.
Tracking social needs can provide information on barriers to controlling hypertension and the need for wraparound services. No recent studies have examined ICD-10-CM social determinants of health-related Z codes (Z55-Z65) to indicate social needs with a focus on patients with hypertension.
Three cohorts were identified with a diagnosis of hypertension during 2016-2017 and continuously enrolled in fee-for-service insurance through June 2021: (1) commercial, age 18-64 years (=1,024,012); (2) private insurance to supplement Medicare (Medicare Supplement), age ≥65 years (=296,340); and (3) Medicaid, age ≥18 years (=146,484). Both the proportion of patients and healthcare encounters or visits with social determinants of health-related Z code were summarized annually. Patient and visit characteristics were summarized for 2019.
In 2020, the highest annual documentation of social determinants of health-related Z codes was among Medicaid beneficiaries (3.02%, 0.46% commercial, 0.42% Medicare Supplement); documentation was higher among inpatient than among outpatient visits for all insurance types. Z63 (related to primary support group) was more common among commercial and Medicare Supplement beneficiaries, and Z59 (housing and economic circumstances) was more common among Medicaid beneficiaries. The 2019 total unadjusted medical expenditures were 1.85, 1.78, and 1.61 times higher for those with social determinants of health-related Z code than for those without commercial, Medicare Supplement, and Medicaid, respectively. Patients with social determinants of health-related Z code also had higher proportions of diagnosed chronic conditions. Among Medicaid beneficiaries, differences in the presence of social determinants of health-related Z code by race or ethnicity were observed.
Although currently underreported, social determinants of health-related Z codes provide an opportunity to integrate social and medical data and may help decision makers understand the need for additional services among individuals with hypertension.
追踪社会需求可以提供有关控制高血压的障碍以及全方位服务需求的信息。最近没有研究检查与健康相关的Z代码（Z55-Z65）的国际疾病分类第十次修订本（ICD-10-CM）社会决定因素，以表明以高血压患者为重点的社会需求。
确定了三个队列，这些队列在2016-2017年期间被诊断患有高血压，并在2021年6月之前持续参加了按服务收费保险：（1）商业保险，年龄18-64岁（=1,024,012）；（2）补充医疗保险的私人保险（医疗保险补充），年龄≥65岁（=296,340）；以及（3）医疗补助，年龄≥18岁（=146,484）。每年汇总患者比例以及与健康相关的Z代码社会决定因素的医疗保健接触或就诊情况。总结了2019年患者和就诊特征。
2020年，与健康相关的Z代码社会决定因素的年度记录最高的是医疗补助受益人（3.02%，商业保险为0.46%，医疗保险补充为0.42%）；所有保险类型的住院就诊记录都高于门诊就诊记录。Z63（与主要支持群体有关）在商业保险和医疗保险补充受益人中更为常见，而Z59（住房和经济状况）在医疗补助受益人中更为常见。2019年，与健康相关的Z代码社会决定因素的患者未经调整的总医疗支出分别比没有商业保险、医疗保险补充和医疗补助的患者高出1.85倍、1.78倍和1.61倍。与健康相关的Z代码社会决定因素的患者被诊断出的慢性病比例也更高。在医疗补助受益人中，观察到按种族或族裔划分的与健康相关的Z代码社会决定因素存在差异。
尽管目前报告不足，但与健康相关的Z代码社会决定因素提供了整合社会和医疗数据的机会，并可能有助于决策者了解高血压患者对额外服务的需求。
