Documentation of social determinants of health for patients with type 2 diabetes in Epic Cosmos

Polina V Kukhareva; Matthew J O’Brien; Daniel C Malone; Kensaku Kawamoto; Ramkiran Gouripeddi; Deepika Reddy; Mingyuan Zhang; Vikrant G Deshmukh; David Danks; Julio C Facelli

doi:10.1093/jamiaopen/ooaf095

journal article Open Access Sep 02, 2025

Documentation of social determinants of health for patients with type 2 diabetes in Epic Cosmos

Polina V Kukhareva

Matthew J O’Brien Daniel C Malone

Kensaku Kawamoto

Ramkiran Gouripeddi

Deepika Reddy Mingyuan Zhang

Vikrant G Deshmukh David Danks

Julio C Facelli

JAMIA Open Vol. 8 No. 5 · Oxford University Press (OUP)

View at Publisher Save 10.1093/jamiaopen/ooaf095

Abstract

Abstract

Objectives
Type 2 diabetes (T2D) is a growing public health burden with persistent racial and ethnic disparities. . This study assessed the completeness of social determinants of health (SdoH) data for patients with T2D in Epic Cosmos, a nationwide, cross-institutional electronic health recors (EHR) database.

Materials and Methods
The study included adults with T2D (ICD-10: E11.*) with encounters between 2022 and 2024. We analyzed 11 individual-level SDoH data elements across 5 domains—financial strain, food insecurity, housing instability, intimate partner violence, and transportation needs—and 4 components of the Social Vulnerability Index (SVI), representing neighborhood-level SDoH. Data completeness for each data element (ie, the proportion of individuals with non-missing values) was evaluated using generalized linear models, adjusting for source healthcare organization, sex, and age.

Results
Among 12 031 927 individuals with T2D, adjusted completeness for individual-level SDoH data elements ranged from 11.2% to 31.5%, varying by data element and racial/ethnic group. American Indian or Alaska Native, Asian, Hispanic, and Native Hawaiian or Other Pacific Islander individuals had lower completeness for all individual-level SDoH compared to White individuals. In contrast, SVI data elements were available for nearly all patients since they are derived from patient addresses routinely collected in EHRs.

Discussion
While SVI data elements were widely available, individual-level SDoH data elements had significant missingness, limiting their usability for secondary analyses. Racial/ethnic disparities in SDoH completeness further complicate their use.

Conclusion
Standardized, equitable SDoH collection is critical to close documentation gaps, reduce disparities, and enable accurate, bias-resistant analyses in T2D care.

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Details

Published: Sep 02, 2025
Vol/Issue: 8(5)
License: View

Authors

P

Polina V Kukhareva

Department of Biomedical Informatics, University of Utah , Salt Lake City, UT 84108,

M

Matthew J O’Brien

Department of General Internal Medicine, Northwestern University , Chicago, IL 60611,

D

Daniel C Malone

Department of Pharmacotherapy, University of Utah , Salt Lake City, UT 84108,

K

Kensaku Kawamoto

Department of Biomedical Informatics, University of Utah , Salt Lake City, UT 84108,

R

Ramkiran Gouripeddi

Department of Biomedical Informatics, University of Utah , Salt Lake City, UT 84108,

D

Deepika Reddy

Diabetes and Endocrinology Center, University of Utah , Salt Lake City, UT 84108,

M

Mingyuan Zhang

Department of Population Health Sciences, University of Utah , Salt Lake City, UT 84102,

V

Vikrant G Deshmukh

Department of Biomedical Informatics, University of Utah , Salt Lake City, UT 84108,

D

David Danks

Department of Computer Science and Engineering, University of California , San Diego, CA 92093,

J

Julio C Facelli

Department of Biomedical Informatics, University of Utah , Salt Lake City, UT 84108,

Cite This Article

Polina V Kukhareva, Matthew J O’Brien, Daniel C Malone, et al. (2025). Documentation of social determinants of health for patients with type 2 diabetes in Epic Cosmos. JAMIA Open, 8(5). https://doi.org/10.1093/jamiaopen/ooaf095

Documentation of social determinants of health for patients with type 2 diabetes in Epic Cosmos

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