{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:32:44Z","timestamp":1786354364205,"version":"build-2736575974"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000054","name":"NCI","doi-asserted-by":"publisher","award":["P30CA016672"],"award-info":[{"award-number":["P30CA016672"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009634","name":"Komen","doi-asserted-by":"crossref","award":["SAC150061"],"award-info":[{"award-number":["SAC150061"]}],"id":[{"id":"10.13039\/100009634","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Social determinants of health (SDOH) affect long-term cancer outcomes. Since 2015, the Centers for Medicare &amp; Medicaid Services recommends using International Classification of Diseases diagnosis codes Z55-Z65 to document specific SDOH. We examined the association of these Z-codes with survival in patients with cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with breast, colorectal, lung, prostate, or pancreatic cancer were identified in the SEER-Medicare database (2016 to 2019). The primary exposure was a Z-code claim in the 12\u2009months before or 6\u2009months after cancer diagnosis. The primary outcome was overall survival. Multivariable Cox regression was performed to examine the association of Z-code claims with overall survival, controlling for demographic and clinical covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 210,093 patients, 4351 (2.1%) had at least one Z-code claim. The most frequent codes were for problems with social environment (Z60: 47.3%) or a primary support group (Z63: 27.2%). Codes were submitted most often by home health agencies (57.8%) and least often by inpatient facilities (1.7%). In adjusted analyses, any Z-code claim was associated with worse survival than was no claim (hazard ratio, 1.09 [95% CI = 1.05 to 1.14]; P\u2009&amp;lt;\u2009.01), although the associations varied by Z-code.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SDOH Z-codes are rarely submitted with billing claims for Medicare patients with cancer. Whether Z-codes reflect the social needs of patients with cancer remains unclear. With current coding, any SDOH Z-code is associated with poor survival in these patients, but individual Z-codes are not consistently associated with survival. Further studies should determine whether SDOH Z-codes enable effective risk adjustment in a value-based health-care system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djag079","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T17:38:19Z","timestamp":1773855499000},"page":"1453-1460","source":"Crossref","is-referenced-by-count":0,"title":["Association of social determinants of health diagnosis codes with overall survival in Medicare-insured patients with cancer"],"prefix":"10.1093","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0503-3739","authenticated-orcid":false,"given":"Joshua N","family":"Herb","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center , Houston, TX,","place":["United States"]},{"name":"Department of Surgery, WakeMed Health and Hospitals , Raleigh, NC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1246-6348","authenticated-orcid":false,"given":"Chung-Yuan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center , Houston, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8700-2767","authenticated-orcid":false,"given":"Sharon H","family":"Giordano","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, The University of Texas MD Anderson Cancer Center , Houston, TX,","place":["United States"]},{"name":"Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center , Houston, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9758-5361","authenticated-orcid":false,"given":"George J","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center , Houston, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2485-2481","authenticated-orcid":false,"given":"Rebecca A","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center , Houston, TX,","place":["United States"]},{"name":"Department of Health Services Research, The University of Texas MD Anderson Cancer Center , Houston, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026081005041361300_djag079-B1","author":"World Health Organization"},{"key":"2026081005041361300_djag079-B2","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.amepre.2015.08.024","article-title":"County health rankings: relationships between determinant factors and health outcomes","volume":"50","author":"Hood","year":"2016","journal-title":"Am J Prev Med"},{"key":"2026081005041361300_djag079-B3","author":"Robert Wood Johnson Foundation","year":"2019"},{"key":"2026081005041361300_djag079-B4","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1200\/OP.23.00810","article-title":"Social determinants of health and cancer care: an ASCO policy statement","volume":"20","author":"Tucker-Seeley","year":"2024","journal-title":"JCO Oncol Pract"},{"key":"2026081005041361300_djag079-B5","first-page":"31","article-title":"Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy","volume":"70","author":"Alcaraz","year":"2020","journal-title":"CA Cancer J Clin"},{"key":"2026081005041361300_djag079-B6","author":"CMS Framework for Health Equity 2022-2032","year":"2024"},{"key":"2026081005041361300_djag079-B7","author":"Improving the Collection of Social Determinants of Health Data with ICD-10-CM Z Codes","year":"2023"},{"key":"2026081005041361300_djag079-B8","author":"Graboyes","year":"2023"},{"key":"2026081005041361300_djag079-B9","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1245\/s10434-023-14501-4","article-title":"Association of ICD-10 clinical modification codes for social determinants of health with surgical outcomes and hospital charges among cancer patients","volume":"31","author":"Diaz","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"2026081005041361300_djag079-B10","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1097\/MLR.0000000000001418","article-title":"Utilization of social determinants of health ICD-10 Z-codes among hospitalized patients in the United States, 2016-2017","volume":"58","author":"Truong","year":"2020","journal-title":"Med Care"},{"key":"2026081005041361300_djag079-B11","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.amjsurg.2023.06.030","article-title":"National patterns in the use of international statistical classification of diseases and health related problems, tenth revision Z codes in ambulatory surgery from 2016 to 2019","volume":"228","author":"Das","year":"2024","journal-title":"Am J Surg"},{"key":"2026081005041361300_djag079-B12","doi-asserted-by":"crossref","first-page":"100089","DOI":"10.1016\/j.focus.2023.100089","article-title":"Social determinants of health\u2013related Z codes and health care among patients with hypertension","volume":"2","author":"Lee","year":"2023","journal-title":"AJPM Focus"},{"key":"2026081005041361300_djag079-B13","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/cncr.33894","article-title":"Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study","volume":"128","author":"Pinheiro","year":"2022","journal-title":"Cancer"},{"key":"2026081005041361300_djag079-B14","author":"Maksut","year":"2021"},{"key":"2026081005041361300_djag079-B15","first-page":"1","article-title":"Measurement bias in documentation of social risk among Medicare beneficiaries","volume":"6","author":"Chatterjee","year":"2025","journal-title":"JAMA Heal Forum"},{"key":"2026081005041361300_djag079-B16","year":"2025"},{"key":"2026081005041361300_djag079-B17","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1200\/OP.23.00703","article-title":"Correlation of patient-reported social determinants of health with census tract measures of socioeconomic disadvantage in patients with GI cancers in eastern North Carolina","volume":"20","author":"Hao","year":"2024","journal-title":"JCO Oncol Pract"},{"key":"2026081005041361300_djag079-B18","author":"Ubri","year":"2022"},{"key":"2026081005041361300_djag079-B19","author":"Regulatory Requirements for Social Determinants of Health Data","year":"2024"},{"key":"2026081005041361300_djag079-B20","author":"Introduction to Social Determinants of Health (SDOH) Screening Tools"}],"container-title":["JNCI: Journal of the National Cancer Institute"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djag079\/67392306\/djag079.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/118\/8\/1453\/67392306\/djag079.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/118\/8\/1453\/67392306\/djag079.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:04:18Z","timestamp":1786352658000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jnci\/article\/118\/8\/1453\/8527871"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,3,18]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jnci\/djag079","relation":{},"ISSN":["0027-8874","1460-2105"],"issn-type":[{"value":"0027-8874","type":"print"},{"value":"1460-2105","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,3,18]]}}}