Sociodemographic Factors Affect Health Outcomes

A large and growing body of evidence shows that sociodemographic factors – age, race, ethnicity, and language, for example – and socioeconomic status (SES), such as income and education, can influence health outcomes. These findings are particularly significant for payment programs that reward or penalize hospitals for the quality of care they provide.

Experts, including an ad-hoc committee of the National Academies of Sciences, Engineering, and Medicine, have examined how social risk factors affect health outcomes and proposed accounting for these factors in Medicare payment programs that, without risk adjustment, disproportionately penalize hospitals that serve vulnerable people. Risk adjustment can include stratified public reporting for patient characteristics, adjustment of performance scores, direct adjustment of payment, and restructured payment incentives.

America’s Essential Hospitals supports including sociodemographic and socioeconomic factors in the risk adjustment of outcomes measures when conceptual and empirical evidence warrants it. Doing so will improve the science of performance measurement by increasing precision and delivering more accurate information to providers, payers, and the public.

Here, find a periodically updated list of research and other resources on the need to risk adjust performance measures for socioeconomic and sociodemographic factors. For further information or to add to this list, please contact INSTITUTE.admin@essentialhospitals.org.

The Evidence for SES Risk Adjustment

Disparate Impact: How Colorblind Policies Exacerbate Black — White Health Inequities	Annals of Internal Medicine	September 2021
Value-Based Payments Disproportionately Impact Safety-Net Hospitals	Journal of the American Medical Association	July 2020
Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program	Health Services Research Journal	March 2019
The hospital readmission reduction program and social risk	Health Services Research Journal	March 2019
Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular intervention	Journal of Vascular Surgery	February 2018
Effect of a Hospital-wide Measure on the Readmissions Reduction Program	New England Journal of Medicine	October 2017
Report on the effect of social risk factors in Medicare’s value-based payment programs	Office of the Assistant Secretary for Planning and Evaluation (ASPE)	December 2016
Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care	Health Affairs	October 2016
Association of Social Determinants With Children’s Hospitals’ Preventable Readmissions Performance	JAMA Pediatrics	April 2016
Patient Factors Predictive of Hospital Readmissions Within 30 Days	Journal for Healthcare Quality	March 2016
Do hospital factors impact readmissions and mortality after colorectal resections at minority-serving hospitals?	Surgery Journal	February 2016
Patient Characteristics and Differences in Hospital Readmission Rates	JAMA Internal Medicine	November 2015
Hospital-Level Factors Related to 30-Day Readmission Rates	American Journal of Medical Quality	November 2015
Demographic factors and hospital size predict patient satisfaction variance—implications for hospital value-based purchasing	Journal of Hospital Medicine	August 2015
Designing Smarter Pay-for-Performance—Let’s Not Go down This Path	3M Health Information Systems (blog)	February 2015
Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study	Annals of Internal Medicine	December 2014
Socioeconomic factors and the risk for sarcoma.	European Journal of Cancer Prevention	November 2014
Rethinking the Social History	New England Journal of Medicine	October 2014
The Risks of Not Adjusting Performance Measures for Patient Sociodemographic Factors	Annals of Internal Medicine	October 2014
Place of Residence and Outcomes of Patients With Heart Failure: Analysis From the Telemonitoring to Improve Heart Failure Outcomes Trial	Circulation: Cardiovascular Quality and Outcomes	September 2014
Changing my mind on SES Risk Adjustment	The Health Care Blog	September 2014
Quality Reporting That Addresses Disparities in Health Care	The Journal of the American MedicalAssociation	July 2014
Adding Socioeconomic Data To Hospital Readmissions Calculations May Produce More Useful Results	Health Affairs	May 2014
Socioeconomic Status And Readmissions: Evidence From An Urban Teaching Hospital	Health Affairs	May 2014
Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristics	Journal of General Internal Medicine	April 2014
A Path Forward on Medicare Readmissions	New England Journal of Medicine	March 2013
Socio-Economic Inequalities: A Review of Methodological Issues and the Relationships with Cancer Survival	Critical Reviews in Oncology and Hematology	March 2013
Patients Living in Impoverished Areas Have More Severe Ischemic Strokes	Stroke	August 2012
The Changing Face of Primary Open-Angle Glaucoma in the United States: Demographic and Geographic Changes from 2011-2050	American Journal of Ophthalmology	April 2012
Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care	The Journal of the American Medical Association	February 2011
The Role of Early-Life Socioeconomic Status in Breast Cancer Incidence and Mortality: Unraveling Life Course Mechanisms	Journal of Aging and Health	March 2012
Risk Prediction Models for Hospital Readmission	The Journal of the American Medical Association	October 2011
Gender, Race, and Socioeconomic Status Affects Outcomes After Lung Cancer Resections in the United States	The Annals of Thoracic Surgery	August 2011
Considerations of Culture and Social Class for Families Facing Cancer: The Need for a New Model for Health Promotion and Psychosocial Intervention	Families, Systems, & Health	June 2011
Patient socioeconomic status is an independent predictor of operative mortality	Annals of Surgery	September 2010
Associations of Social Networks with Cancer Mortality: A Meta-Analysis	Critical Reviews in Oncology/Hematology	August 2010
The Family-Centered Medical Home: Specific Considerations for Child Health Research and Policy	Academic Pediatrics	July 2010
Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California	Cancer Causes Control	October 2009
Socioeconomic status and surgical mortality in the elderly	Medical Care	September 2008
Will Pay-For-Performance And Quality Reporting Affect Health Care Disparities?	Health Affairs	May 2007
Prevalence of Open-Angle Glaucoma and Ocular Hypertension in Latinos: the Los Angeles Latino Eye Study	Ophthalmology	August 2004
Socioeconomic Risk Factors for Breast Cancer: Distinguishing Individual- and Community-Level Effects	Epidemiology	July 2004
Racial Differences in the Cause-Specific Prevalence of Blindness in East Baltimore	New England Journal of Medicine	November 1991