Lack of key variables reflecting patients' socioeconomic status, such as income, education level, and occupation

The gap

Evidence profile

Sourced from the limitations section and limitations of the source papers, classified as general, drawn from work published between 2025 and 2026, spanning 3 journals. Those papers have been cited 7 times in total.

Supporting evidence — 3 representative gaps

• The Burden of Hospital Illness Associated with Disseminated Versus Isolated Pulmonary Coccidioidomycosis in the United States (2025) · Journal of Fungi · cited 3× · doi

  no validation studies assessing the sensitivity and specificity of billing codes for coccidioidomycosis have been published, - misclassification due to miscoding cannot be ruled out, - unable to further subset DCM hospitalizations due to a lack of detail in current ICD-10 billing codes, - unable to determine for how long patients had had coccidioidomycosis prior to hospitalizations, - the cause of death is not distinguishable in the National Inpatient Sample database, - the National Inpatient Sample database does not contain inpatient or outpatient medication data

  generallimitations section
  Keywords: validation studies assessing sensitivity specificity billing codes coccidioidomycosis
• Medicaid Service Utilization by Beneficiaries with Rare Diseases (2026) · Zenodo (CERN European Organization for Nuclear Research) · doi

  The authors acknowledge this analysis has limitations. First, research suggests that perhaps only one or two of every 10 RDs actually has a specific ICD-10 code.15 Thus, this analysis can be most accurately described as examining characteristics of Medicaid enrollees with a diagnosed and known RD. In reality, the number of Americans with Medicaid coverage who have a RD is likely to be higher than reported in the dataset. Second, claims are used as a proxy for the presence of a RD without any further clinical diagnostic validation, such as cross-referencing claims against patient electronic health record (EHR) data to confirm the diagnosis. By relying only on claims data, we are unable to discern a differential (i.e., unconfirmed) diagnosis from a confirmed diagnosis.16 Third, the relationship between a disease concept and a single ICD-10 code is not always one-to-one. This relationship can vary because of overlapping symptoms, varying disease stages, or coding conventions. Finally, the state of Medicaid data is imperfect and constantly evolving. Most importantly, the COVID-19 public health emergency and Medicaid-related provisions did not expire until spring 2023, and Medicaid enrollment during that period was consequently higher.17 And additional changes are on the horizon as OBBBA ushers in sweeping and novel changes to state Medicaid programs.

  generallimitationsevidence 5/5
  Keywords: medicaid claims diagnosis code examining higher further health relationship disease state changes authors acknowledge limitations
• Complication development trajectories for patients with type 2 diabetes mellitus: evidence from a five-million retrospective cohort study (2025) · Frontiers in Health Services · cited 4× · doi

  lack of key variables reflecting patients' socioeconomic status, such as income, education level, and occupation - diagnoses relied on electronic medical records and ICD-10 codes, which may have been subject to underreporting or misclassification - patient engagement and data completeness may affect behavioral measures, such as follow-up frequency and medication adherence - complication data were primarily obtained from inpatient records, which may have resulted in a higher-risk cohort and an overestimation of complication incidence

  generallimitations sectionevidence 5/5
  Keywords: lack key variables reflecting patients socioeconomic status income

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