SDOH: Social Determinants of Health
Social Determinants of Health (SDOH) are the non-medical conditions in which people are born, grow, live, work, and age — accounting for 30–55% of health outcomes and increasingly captured in clinical workflows via Z-codes and standardised screening tools.
What are Social Determinants of Health?
The World Health Organization defines Social Determinants of Health as "the conditions in which people are born, grow, live, work and age." These include economic stability (income, employment, food security, housing stability), education access and quality, social and community context (social cohesion, discrimination), health care access and quality, and neighbourhood and built environment (housing quality, transportation, environmental conditions). Research consistently demonstrates that SDOH account for 30–55% of health outcomes — in some studies more than clinical care itself.
ICD-10 Z-Codes for Social Needs
ICD-10-CM Z55–Z65 codes document social determinants in the medical record. Key codes include:
- Z59.0–Z59.9: Problems related to housing and economic circumstances (homelessness, inadequate housing, food insecurity)
- Z60.0–Z60.9: Problems related to social environment (isolation, discrimination)
- Z63.0–Z63.9: Problems related to primary support group (family, caregiver stress)
- Z56.0–Z56.9: Problems related to employment and unemployment
SDOH Screening Tools
Commonly used SDOH screening tools include: PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences), the Accountable Health Communities Health-Related Social Needs (HRSN) Screening Tool (CMS-developed), the Hunger Vital Sign for food insecurity, and AHC-HRSN. CMS began including SDOH screening as an AWV element and incorporated SDOH measures into MIPS Improvement Activities.
SDOH Impact on Clinical Analytics
SDOH significantly predicts readmission risk, medication adherence, quality measure performance, and healthcare utilisation patterns. Patients with documented food insecurity are 2× more likely to have poor diabetes control; patients with housing instability are 3× more likely to be readmitted. Analytics that incorporate SDOH screening data alongside clinical data enable more accurate risk stratification and identify social needs-driven care gaps that clinical interventions alone cannot close.