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Abstract: PO0475

Low Documentation of Social Determinants of Health Among US Veterans and Medicare Patients with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Han, Yun, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Yin, Maggie, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Wyncott, April, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Bragg-Gresham, Jennifer L., University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
  • Zivin, Kara, University of Michigan, Ann Arbor, Michigan, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Mercado, Carla I., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Tuot, Delphine S., University of California San Francisco, San Francisco, California, United States
  • Powe, Neil R., University of California San Francisco, San Francisco, California, United States
  • Saran, Rajiv, University of Michigan Division of Nephrology, Ann Arbor, Michigan, United States
Background

The implementation of ICD-10 codes in 2015 included new codes (Z-codes) to identify social determinants of health (SDOH). We sought to identify differences in SDOH-related Z-code (SDOH-ZC) utilization in Veterans Health Administration (VHA) and Medicare patients identifying differences in SDOH-ZC utilization in those with and without chronic kidney disease (CKD).

Methods

We used 5% sample of Medicare claims data (2015-2018) and 100% VA health data (2015-2019). A list of SDOH-ZCs were grouped into 17 categories (education and literacy, employment status, occupational risk factors, housing, economic circumstances, lifestyle factors, etc.). Proportion of claims assigned a SDOH-ZC were measured quarterly across different healthcare encounters and described by patient characteristics including age, sex, race, and hypertension, diabetes, and CKD. Use of SDOH-ZC were compared between those with and without CKD.

Results

SDOH-ZCs appeared more frequently in the VA health system than in Medicare data (Fig 1.a-b). Tobacco use was the most common SDOH-ZC in both the Medicare and VA data. More SDOH-ZCs were evident in the VA employment, environment, housing and economic, and family circumstances. Compared to those without CKD, use of SDOH-ZC was higher in individuals with CKD in outpatient settings but lower among those with inpatient visits, observation stays, and emergency department visits (Fig 1.c-d).

Conclusion

We observed lower recording of SDOH overall and among those with CKD in health care settings. Additional efforts might consider increasing SDOH documentation to help assess need for social services, which could potentially reduce disparities in health outcomes by socioeconomic status.

Funding

  • Other U.S. Government Support