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New Study Details Frequency of SDOH Documentation Among Patients With Lung Cancer


A decade’s worth of data included more than 5 million social determinants of health (SDOH) attributes across nearly 2 million clinical notes from the patient visits extrapolated from a natural language processing system.

Offering guidance for future research looking to leverage information on social determinants of health (SDOH) recorded in clinical visits, researchers have published their findings on the documentation of these determinants among a group of patients with lung cancer. The research was published in Frontiers in Public Health.

According to the researchers, their study, to their knowledge, is the first to dig into the documentation frequency of these factors among patients with lung cancer in a real-world setting.

“Many SDoH are associated with cancer risk and cancer treatment outcomes. Yet, information related to SDoH is often unavailable in structured EHRs [electronic health records] but is often documented in clinical notes as free text, making it challenging to examine SDoH in cancer research,” commented the researchers.

They evaluated clinical notes of more than 10,000 patients with lung cancer visiting the University of Florida Health between 2011 and 2020, during which EHR systems underwent rapid adoption. Nearly all (> 95%) of the patients were 50 years old or older. The majority (> 72%) were White.

The decade’s worth of data included over 5 million SDOH attributes across nearly 1.8 million clinical notes from the patient visits extrapolated from a natural language processing system. Fifteen different SDOH were identified, including alcohol use, education, transportation, financial status, and employment status.

The overwhelming majority of patients had gender, alcohol use, or drug use cited in their clinical notes, with 90% of patients having at least 1 of these determinants documented. Across 5 categories of SDOH that were frequently cited—marital status, education, occupation, smoking, and race—70% of patients have at least 1 determinant listed. There were 7 categories—ethnicity, language, physical activity, transportation, financial constraint, social cohesion, and employment status—that were not frequently documented, with less than 60% of patients having at least 1 determinant cited.

The findings come amid increasing attention being paid to how SDOHplay a role in the risk of a gamut of diseases and conditions, including cancer. The researchers of the current study explained: “A recent study reported that up to 75% of cancers occurrences are associated with SDOH rather than clinical factors. Other studies have shown that many SDOH contribute to individual cancer risk, influence the likelihood of survival, and affect cancer early prevention and health equity.”

Previous research has indicated that determinants like poverty and lack of education could impact breast cancer stage and survival outcomes. Additionally, research has also shown that SDOHaffect screening for various cancers, including cervical cancer, breast cancer, and lung cancer.


Yu Z, Yang X, Bian J, Qu Y. Assessing the documentation of social determinants of health for lung cancer patients in clinical narratives. Front Public Health. Published online March 28, 2022. doi:10.3389/fpubh.2022.778463

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