Victims of human trafficking and exploitation in the healthcare system: a retrospective study using a large multi-state dataset and ICD-10 codes

Abstract

Background. Trafficking and exploitation for sex or labor affects millions of persons worldwide, but their use of the healthcare system is not characterized systematically. In 2018 new ICD-10 codes were implemented in the US for diagnosis of patients who were victims of trafficking or exploitation but todate no comprehensive study reported on their medical journeys. Our objective was to examine the extent to which newly implemented ICD-10 codes pertaining to human trafficking were being used in the healthcare system, and to characterize the care received by the victims. Methods and Findings. Database search of a large US health insurer that contained approximately 43 million patients holding commercial or government-provided health insurance across the United States (US). For the dates 2018-09-01 to 2022-03-01, the dataset was found to contain 3,967 instances of the ICD-10 codes. In 31% of the cases, the codes were used as the principal or admitting diagnosis. Regression analysis of the codes found a 2% increase in the adoption of these codes. The codes were used by 1,532 distinct providers, the majority in non-hospital settings. The data contained 2301 patients of which 1025 were treated for recent exploitation or trafficking, which corresponds to identification of 13 new patients each week. Of the latter patients, 90.1% were victims of sexual exploitation, and 9.9% victims of labor exploitation. The patients were predominantly female (81%), insured by Medicaid (60%) and the median age was 20 (interquartile range: 15-35). Healthcare utilization over 12 months after diagnosis of trafficking was $32,192 (standard deviation: $160,730) - much greater than average for Medicaid patients ($6,556 per year in 2019). The victims were characterized by a high prevalence of mental health conditions, high utilization of the emergency department, and these persisted after diagnosis of exploitation. Surprisingly, 57% of the victims were first diagnosed outside hospitals, primarily during office and psychiatric visits, and only 25% were first diagnosed during an emergency department visit. Conclusions. The new ICD-10 codes provide valuable insights into the profiles and medical journeys of victims of trafficking. However, adoption of the codes is not widespread, increasing by only 2% per year and the majority of the victims are likely still not diagnosed by the new codes. Greater adoption, when consistent with patient safety, may improve care coordination and outcomes.