Documentation of social determinants of health for patients with type 2 diabetes in Epic Cosmos.

OBJECTIVES

Type 2 diabetes (T2D) is a growing public health burden with persistent racial and ethnic disparities. . This study assessed the completeness of social determinants of health (SdoH) data for patients with T2D in Epic Cosmos, a nationwide, cross-institutional electronic health recors (EHR) database.

MATERIALS AND METHODS

The study included adults with T2D (ICD-10: E11.*) with encounters between 2022 and 2024. We analyzed 11 individual-level SDoH data elements across 5 domains-financial strain, food insecurity, housing instability, intimate partner violence, and transportation needs-and 4 components of the Social Vulnerability Index (SVI), representing neighborhood-level SDoH. Data completeness for each data element (ie, the proportion of individuals with non-missing values) was evaluated using generalized linear models, adjusting for source healthcare organization, sex, and age.

RESULTS

Among 12 031 927 individuals with T2D, adjusted completeness for individual-level SDoH data elements ranged from 11.2% to 31.5%, varying by data element and racial/ethnic group. American Indian or Alaska Native, Asian, Hispanic, and Native Hawaiian or Other Pacific Islander individuals had lower completeness for all individual-level SDoH compared to White individuals. In contrast, SVI data elements were available for nearly all patients since they are derived from patient addresses routinely collected in EHRs.

DISCUSSION

While SVI data elements were widely available, individual-level SDoH data elements had significant missingness, limiting their usability for secondary analyses. Racial/ethnic disparities in SDoH completeness further complicate their use.

CONCLUSION

Standardized, equitable SDoH collection is critical to close documentation gaps, reduce disparities, and enable accurate, bias-resistant analyses in T2D care.