BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Billig et al. (2026) studied this question.