Fernandes Sara, Pauly Vanessa, Klay Sophie, Orleans Veronica, Brousse Yann, Tran Bach, Rahmati Masoud, Yon Dong Keon, Smith Lee, Fond Guillaume, Lemoine Coralie, Antonini Francois, Boussat Bastien, Agard Geoffray, Boyer Laurent
CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France.
Department of Public Health, AP-HM, Marseille, France.
BMC Public Health. 2025 Jul 2;25(1):2225. doi: 10.1186/s12889-025-23442-4.
Health is shaped by a complex network of socio-economic, environmental and behavioral factors, known as social determinants of health (SDOH). SDOH can be optionally documented using Z codes from the International Classification of Diseases, Tenth Revision (ICD-10) in the French national hospital database. This study aimed to (a) describe the use of SDOH codes among adult inpatients in France in 2022, and temporal trends from 2014 to 2022; and (b) identify the characteristics of hospital stays associated with the presence of SDOH codes.
We conducted a nationwide retrospective, cross-sectional, observational study using the French national hospital database. All stays for patients aged 18 years or older in acute care hospitals between 2014 and 2022 were included. The outcome was the presence of at least one SDOH code (Z55-Z75). Temporal trends in the use of SDOH codes from 2014 to 2022 were analyzed using univariable linear regression. Univariable and multivariable mixed-effects models were used to identify characteristics of hospital stays associated with SDOH codes for the year 2022.
From 2014 to 2022, 83,741,127 stays were identified, of which 6,321,390 (7.6%) had at least one SDOH code. Among 8.6 million hospital stays in 2022, 9.4% included an SDOH code, primarily documenting social conditions (6.5%), environmental (2.5%), and economic housing (1.2%) domains. There was an increase in the reporting SDOH codes from 2014 (5.0%) to 2022 (9.4%). In the multivariable analysis, the presence of at least one SDOH code was associated with female sex (adjusted odds ratio (aOR = 1.34, 95%CI [1.33;1.34]), being aged 65-74 years (aOR = 1.26 [1.25;1.28]) or older (aOR = 2.25 [2.40;2.45]) compared with the 18-34 age group, receiving social assistance, particularly state medical assistance (aOR = 4. 02 [3.93;4.11]), having comorbidities (1-2: aOR = 1.44 [1.43;1.45]; ≥3: aOR = 1.70 [1.69;1.71]), mental disorders (aOR = 3.44 [3.40;3.49]), and hospitalization in public hospitals, especially non-academic public hospitals (aOR = 7.19 [7.01;7.38]).
Despite the observed increase in SDOH coding between 2014 and 2022, our study suggests that their use remains limited in France. These findings highlight the need for a national strategy to promote systematic SDOH documentation and their integration into care, supported by adequate funding, ultimately fostering more equitable healthcare delivery that integrates medical and social needs into clinical practice.
健康由社会经济、环境和行为因素等复杂网络塑造，这些因素被称为健康的社会决定因素（SDOH）。在法国国家医院数据库中，可以选择使用国际疾病分类第十版（ICD - 10）中的Z编码来记录SDOH。本研究旨在（a）描述2022年法国成年住院患者中SDOH编码的使用情况以及2014年至2022年的时间趋势；（b）确定与存在SDOH编码相关的住院特征。
我们使用法国国家医院数据库进行了一项全国性的回顾性横断面观察研究。纳入了2014年至2022年期间18岁及以上患者在急症医院的所有住院病例。观察指标是至少存在一个SDOH编码（Z55 - Z75）。使用单变量线性回归分析2014年至2022年SDOH编码使用的时间趋势。使用单变量和多变量混合效应模型来确定2022年与SDOH编码相关的住院特征。
2014年至2022年期间，共识别出83,741,127例住院病例，其中6,321,390例（7.6%）至少有一个SDOH编码。在2022年的860万例住院病例中，9.4%包含SDOH编码，主要记录社会状况（6.5%）、环境（2.5%）和经济住房（1.2%）领域。从2014年（5.0%）到2022年（9.4%），报告的SDOH编码有所增加。在多变量分析中，至少存在一个SDOH编码与女性性别（调整后的优势比（aOR）= 1.34，95%置信区间[1.33;1.34]）、年龄在65 - 74岁（aOR = 1.26 [1.25;1.28]）或65岁及以上（aOR = 2.25 [2.40;2.45]）（与18 - 34岁年龄组相比）、接受社会援助，特别是国家医疗援助（aOR = 4.02 [3.93;4.11]）、患有合并症（1 - 2种：aOR = 1.44 [1.43;1.45]；≥3种：aOR = 1.70 [1.69;1.71]）、精神障碍（aOR = 3.44 [3.40;3.49]）以及在公立医院住院，尤其是非学术性公立医院（aOR = 7.19 [7.01;7.38]）有关。
尽管在2014年至2022年期间观察到SDOH编码的使用有所增加，但我们的研究表明其在法国的使用仍然有限。这些发现凸显了制定一项国家战略的必要性，以促进系统的SDOH记录并将其纳入医疗护理，同时要有充足的资金支持，最终推动更公平的医疗服务提供，将医疗和社会需求融入临床实践。
