Use of Z-codes related to social determinants of health among adult inpatients in France: a nationwide study from 2014 to 2022
Bibliographic record
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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]). CONCLUSION: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".