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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

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


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