Title : Impact of documented social determinants of health (ICD-10 Z Codes) on emergency department outcomes in ectopic pregnancy
Abstract:
Objective: This study characterizes the demographic and clinical profile of patients with documented social determinants of health (SDOH) ICD-10 Z codes (Z55–Z65) presenting to the emergency department (ED) with ectopic pregnancy, and explores healthcare utilization and management patterns.
Methods: This retrospective cohort study used TriNetX Research Network data to compare adult females (18-49) presenting to the ED with diagnosed ectopic pregnancy between 01/01/2000 - 01/01/2024, by presence or absence of SDOH Z codes. Propensity score matching balanced baseline demographics and comorbidities. Outcomes assessed over one year after the index event included surgical intervention, hospital admission, ED revisits, analgesic use, mental health diagnoses, and follow-up for gynecologic care, contraception, and sterilization. Risk analyses compared outcome proportions between cohorts, reported as risk ratios (RR) with 95% confidence intervals.
Results: 15,080 matched patients were analyzed. Patients with documented SDOH Z codes were more likely to be hospitalized (RR: 1.473, p<0.0001), revisit the ED (RR:1.095, p<0.0001), undergo delayed surgery (RR: 2.030), experience new diagnoses of depression (RR: 1.846, p<0.0001), anxiety (RR: 1.576, p<0.0001), and post-traumatic stress disorder (RR: 2.980, p<0.0001), and have higher opioid use (RR: 1.102, p<0.0001). They were also more likely to pursue follow-up care for contraception (RR: 1.429, p<0.0001) and sterilization (RR: 1.928, p<0.0001).
Conclusion: Documented SDOH Z codes were associated with increased risk of hospitalization, ED repeat visits, delayed surgery, and mental health conditions.
