| Title: | Psychosocial adversity captured by ICD-10 Z-codes and mortality risk: evidence from the UK Biobank |
| Journal: | GeroScience |
| Published: | 20 Jun 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/42322547/ |
| DOI: | https://doi.org/10.1007/s11357-026-02368-8 |
Publication 20588
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Abstract
Psychosocial adversity is a major determinant of health, but the mortality associations of its clinical documentation via ICD-10 Z55-Z65 codes remain unclear. We conducted a matched cohort study of UK Biobank participants with linked Hospital Episode Statistics and mortality records. Participants with ≥ 1 ICD-10 Z55-Z65 code recorded between 2010 and 2020 were propensity score-matched (1:1) to hospitalized participants without Z-codes. Mortality follow-up occurred from 2020 to 2023. Associations with all-cause mortality were estimated using Cox proportional hazards models, and cause-specific mortality using Fine-Gray subdistribution hazard models accounting for competing risks. The matched cohort included 13,604 participants (6802 with Z-codes and 6802 without). During a mean follow-up of 3.75 years, mortality rates were 50.8 versus 22.9 deaths per 1000 person-years among participants with and without Z-codes, respectively. Z-code documentation was associated with higher all-cause mortality (HR = 2.02, 95% CI = 1.82, 2.23). Elevated risks were observed across major causes of death, with the strongest association for housing and economic hardship (Z59). Hospital documentation of psychosocial adversity (ICD-10 Z55-Z65 codes) was associated with substantially higher mortality and may contribute to population health surveillance when integrated into electronic health records.Graphical abstractExposure identification• UK Biobank participants with ≥1 Z55-Z65 code.• Codes reflect social, economic, and psychosocial adversity.Study design• 1:1 propensity score (PS) matching with hospitalized controls, after alignment of admission dates.• Matched on baseline and admission age, sex, race/ethnicity, TDI, education and income.• Sensitivity analysis for 1:2, 1:3 PS matching and IPTW type of modeling.Analytic approach• Follow-up: 2020-2023.• Cox & Fine-Gray models.• Adjusted for all above factors along with LE8, self-rated health, comorbidities and medication use.Key findings• HR all-cause mortality : HR=2.02; 95% CI: 1.82-2.23.• Elevated external, respiratory and other causes, as well as cancer and CVD mortality. • Housing/Economic adversity (Z59) was consistently the strongest predictor for all-cause mortality, especially in the 1:1 matched cohort.</p>
10 Authors
- May A. Beydoun
- Hind A. Beydoun
- Jack Tsai
- Indira C. Turney
- Osorio Meirelles
- Tianyi Huang
- Nicole Noren Hooten
- Lenore J. Launer
- Michele K. Evans
- Alan B. Zonderman
1 Application
| Application ID | Title |
|---|---|
| 77963 | Dissecting racial/ethnic disparities in dementia traits through socio-economic, lifestyle, cardio-metabolic risk and infectious agents, with focus on Helicobacter pylori sero-positivity |
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