Use of Social Determinants of Health Z-Codes in Hand Trauma Patients

Hand trauma patients are more likely to be affected by social determinants of health (SDOH) that can adversely affect surgical outcomes. The introduction of z-codes reflecting SDOH has increased the ability to systematically capture SDOH, such as economic circumstances and social support. However, little is known about the uptake of z-codes for identifying SDOH and the characteristics of hand trauma patients with and without documented SDOH z-codes.

This analysis used 2015-2025 national data from EPIC Cosmos for patients undergoing common surgical procedures for hand trauma. We assessed for the presence of SDOH using z-codes and compared characteristics of patients with and without documented SDOH.

Only 1.7% of surgically treated hand trauma patients had documented SDOH z-codes. Patients with SDOH were younger, Black, living in urban areas, and insured through Medicaid or Medicare compared with patients without SDOH. Between 2015 and 2025, the uptake of z-codes increased from 0.4% in 2015 to 4.1% in 2025, with housing, economic, and social support determinants being most common.

While z-codes enable greater capture of SDOH, adoption was limited over the last decade. Strategies are needed to promote more comprehensive identification of SDOH among surgically treated hand trauma populations.