# Comparison of Emergency Department Patients with Salpingitis and Oophoritis with and without Documented Social Determinants of Health

## TL;DR

This study shows that patients with documented social determinants of health have different emergency care outcomes, including more hospitalizations and mental health diagnoses.

## Contribution

The study provides new insights into how social determinants of health affect gynecologic emergency care and patient outcomes.

## Key findings

- Patients with SDoH Z codes were less likely to receive surgery but more likely to be hospitalized.
- They had higher rates of ED revisits, critical care use, and new mental health diagnoses like depression and anxiety.
- These findings emphasize the importance of addressing social determinants in healthcare to improve outcomes.

## Abstract

Social determinants of health (SDoH) have emerged as a critical focus of research due to their significant impact on clinical outcomes; however, there is a gap in research specific to women’s health. Understanding the factors underlying trends in gynecologic emergency diagnoses requires a more comprehensive examination of SDoH. In this study we characterize the demographic and clinical profile of patients with documented SDoH International Classification of Diseases, 10th revision (ICD-10), Z codes (Z55-Z65) who presented to the emergency department (ED) with salpingitis and oophoritis, and explore patterns of healthcare utilization and management.

In this retrospective cohort study we used TriNetX Research Network data to compare adult females (18–49 years of age) presenting to the ED with diagnosed salpingitis and oophoritis between January 1, 2000–January 1, 2024, by presence or absence of SDoH Z codes. Propensity score matching balanced baseline demographics and comorbidities. The outcomes assessed one year from ED presentation included surgical intervention, hospital admission, ED revisits, utilization of critical care service, analgesic use, and new mental health diagnoses such as anxiety, post-traumatic stress disorder, and depression. Risk analyses compared outcome proportions between cohorts, reported as risk ratios (RR) with 95% confidence intervals.

Before propensity score matching, the proportion of the initial cohort that had at least one SDoH Z code was 11.9%. Following propensity score matching, we analyzed 5,570 patients, 50% of whom had documented SDoH Z codes. We found that 10.2% of patients with documented SDoH Z codes received surgery compared to 15.0% of patients without (RR, 0.679; 95% CI, 0.577–0.799, P < .001). On the contrary, 45.7% of patients with Z codes were hospitalized compared to 34.3% without (RR, 1.333; 95% CI, 1.248–1.423, P < .001). Of patients with SDoH Z codes, 58.1% revisited the ED compared to 45.2% without (RR, 1.287; 95% CI, 1.222–1.355, P < .001). 4.4% of patients with Z codes required critical care services compared to 2.5% without (RR, 1.757; 95% CI, 1.317–2.345, P < .001). Lastly, patients with SDoH Z codes experienced new mental health diagnoses. This included 8.4% with Z codes diagnosed with depression (RR, 1.890; 95% CI, 1.432–2.495, P < .001) compared to 4.6% without, 11.1% with Z codes diagnosed with anxiety (RR, 1.565; 95% CI, 1.241–1.973, P < .001) compared to 7.1% without, and 2.7% with Z codes diagnosed with post-traumatic stress disorder (RR, 3.026; 95% CI, 1.897–4.826, P < .001) compared to 0.9% in patients without documented Z codes.

Patients with documented ICD-10 Z codes for social determinants of health were less likely to receive surgery but were associated with increased ED repeat visits, hospitalization, need for critical care, and mental health conditions. These findings highlight the clinical relevance of SDoH in acute care utilization and patient outcomes, underscoring the importance of routine screening and documentation of SDoH in electronic health records. Addressing underlying social needs may be a key strategy in reducing healthcare burden and improving long-term outcomes for vulnerable populations.