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Table 8 SDH factors and related ICD-10 codes

From: Community health center provider ability to identify, treat and account for the social determinants of health: a card study

SDH factor and definition

Related ICD-10 code

Review of code

Educational limitations

Z55.0 - Illiteracy and low-level literacy

Other corresponding ICD-10 codes were related to children in school. Patient may be lacking in health literacy, but have appropriate level of reading literacy. The available code is too specific.

Observed difficulty processing and understanding medical information. Can include difficulty reading, listening, asking questions or applying information.

Language barriers

None identified


Primary language not English; inability to communicate freely and openly with provider.


Z59.5 - Extreme poverty

Relatively good match with the social factor.

Income below poverty line; lack of basic needs such as nutrition, clothing, shelter.

Near poverty

Z59.6 - Low income

Relatively good match with the social factor.

Just enough money to meet basic needs but not enough for extras. Qualifies for sliding fee discounts at FQHC.

Insufficient/Lack of insurance

None identified


Either no health insurance or has insurance which is not sufficient to cover medical expenses or doesn’t cover medications. Prohibits seeking care or follow through.

Food insecurity

Z59.4 - Lack of adequate food and safe drinking water

ICD-10 code is a good match. It may be advantageous to have additional codes which address food availability separately from ability to afford food.

Does not have reliable access to sufficient quantity of affordable, nutritious food. Does not know where next meal is coming from. Might live in food desert.


Z59.0 - Homelessness

Relatively good match with the social factor.

Does not have permanent housing, may live on the streets, in a shelter, mission, abandoned building, vehicle or any unstable non-permanent situation.

Unstable housing

Z59.1 - Inadequate housing

Relatively good match with the social factor.

Lives in several places. Lacks fixed, regular and adequate residence due to loss of housing or economic need. No lease, ownership or occupancy agreement. Unsure if place of shelter will be open for extended period of time.

Unstable work schedule

Z56.3 - Stressful work schedule

ICD-10 code is related, but does not cover a work schedule which may prevent patients from seeking regular medical care.

Difficulty scheduling or keeping appointments due to variable work schedule; multiple jobs, varying start/stop times, long shifts or unsure when will work.

Transportation issues

None identified


Hard to get to appointments due to lack of transportation. Does not own vehicle, can’t afford public transportation, lives far from public transportation or services unreliable.

Family care demands/Issues

Z63.2 - Inadequate family support

ICD-10 code is related, but somewhat different; does not cover patients who are unable to care for themselves due to the demands of family care.

Z63.6 - Dependent relative needing care at home

Responsibilities at home caring for others (children, partner, parents, family) which prevent person from caring for themselves.

Cultural beliefs

Z60.3 - Acculturation difficulty

ICD-10 code is somewhat related but doesn’t specifically cover issues pertaining to cultural beliefs which may prohibit a patient from seeking or following medical advice.

Cultural background is not in concordance with Western Medicine. May believe Western Medicine can be detrimental or is the place of last resort. Beliefs may conflict with medical care - prohibit patient from seeking care or adhering to treatment plan.

Immigrant status

None identified


Not born in US, now living here legally or illegally. Can have difficulty obtaining public assistance if ‘illegal’. May be child with legal status whose parents do not have legal status.

Migrant status

None identified


Person is a migrant worker who relocates frequently due to work availability.

Neighborhood safety

Z59.2 - Discord with Neighbors, lodgers, landlord

ICD-10 code is related but there remains a lack of codes which address safety and environmental issues. The available code does not clearly match the issue.

Not feel safe going outside in neighborhood, threat of crime/violence. Under stress from environment. Children can’t play outside, can’t exercise, hard to get to appointments.

  1. Table 8 provides a listing of the SDH factors used by investigators for this study along with related ICD-10 codes. The last column provides a description of how well the codes are matched