Advocacy Alert

Urge Your Lawmakers to Support Essential Health System Designation

Sociodemographic Factors Affect Health Outcomes

April 18, 2016

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 InequitiesAnnals of Internal MedicineSeptember 2021
Value-Based Payments Disproportionately Impact Safety-Net HospitalsJournal of the American Medical AssociationJuly 2020
Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction programHealth Services Research JournalMarch 2019
The hospital readmission reduction program and social riskHealth Services Research JournalMarch 2019
Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular interventionJournal of Vascular SurgeryFebruary 2018
Effect of a Hospital-wide Measure on the Readmissions Reduction ProgramNew England Journal of MedicineOctober 2017
Report on the effect of social risk factors in Medicare’s value-based payment programsOffice 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 CareHealth AffairsOctober 2016
Association of Social Determinants With Children’s Hospitals’ Preventable Readmissions PerformanceJAMA PediatricsApril 2016
Patient Factors Predictive of Hospital Readmissions Within 30 DaysJournal for Healthcare QualityMarch 2016
Do hospital factors impact readmissions and mortality after colorectal resections at minority-serving hospitals?Surgery JournalFebruary 2016
Patient Characteristics and Differences in Hospital Readmission RatesJAMA Internal MedicineNovember 2015
Hospital-Level Factors Related to 30-Day Readmission RatesAmerican Journal of Medical QualityNovember 2015
Demographic factors and hospital size predict patient satisfaction variance—implications for hospital value-based purchasingJournal of Hospital MedicineAugust 2015
Designing Smarter Pay-for-Performance—Let’s Not Go down This Path3M Health Information Systems (blog)February 2015
Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort StudyAnnals of Internal MedicineDecember 2014
Socioeconomic factors and the risk for sarcoma.European Journal of Cancer PreventionNovember 2014
Rethinking the Social History New England Journal of MedicineOctober 2014
The Risks of Not Adjusting Performance Measures for Patient Sociodemographic FactorsAnnals of Internal MedicineOctober 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 OutcomesSeptember 2014
Changing my mind on SES Risk AdjustmentThe Health Care BlogSeptember 2014
Quality Reporting That Addresses Disparities in Health Care The Journal of the American MedicalAssociationJuly 2014
Adding Socioeconomic Data To Hospital Readmissions Calculations May Produce More Useful ResultsHealth AffairsMay 2014
Socioeconomic Status And Readmissions: Evidence From An Urban Teaching HospitalHealth AffairsMay 2014
Variation in the risk of readmission among hospitals: the relative contribution of patient, hospital and inpatient provider characteristicsJournal of General Internal MedicineApril 2014
A Path Forward on Medicare Readmissions New England Journal of MedicineMarch 2013
Socio-Economic Inequalities: A Review of Methodological Issues and the Relationships with Cancer SurvivalCritical Reviews in Oncology and HematologyMarch 2013
Patients Living in Impoverished Areas Have More Severe Ischemic StrokesStrokeAugust 2012
The Changing Face of Primary Open-Angle Glaucoma in the United States: Demographic and Geographic Changes from 2011-2050American Journal of OphthalmologyApril 2012
Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of CareThe Journal of the American Medical AssociationFebruary 2011
The Role of Early-Life Socioeconomic Status in Breast Cancer Incidence and Mortality: Unraveling Life Course MechanismsJournal of Aging and HealthMarch 2012
Risk Prediction Models for Hospital ReadmissionThe Journal of the American Medical AssociationOctober 2011
Gender, Race, and Socioeconomic Status Affects Outcomes After Lung Cancer Resections in the United StatesThe Annals of Thoracic SurgeryAugust 2011
Considerations of Culture and Social Class for Families Facing Cancer: The Need for a New Model for Health Promotion and Psychosocial InterventionFamilies, Systems, & HealthJune 2011
Patient socioeconomic status is an independent predictor of operative mortalityAnnals of SurgerySeptember 2010
Associations of Social Networks with Cancer Mortality: A Meta-AnalysisCritical Reviews in Oncology/HematologyAugust 2010
The Family-Centered Medical Home: Specific Considerations for Child Health Research and PolicyAcademic PediatricsJuly 2010
Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of CaliforniaCancer Causes ControlOctober 2009
Socioeconomic status and surgical mortality in the elderlyMedical CareSeptember 2008
Will Pay-For-Performance And Quality Reporting Affect Health Care Disparities?Health AffairsMay 2007
Prevalence of Open-Angle Glaucoma and Ocular Hypertension in Latinos: the Los Angeles Latino Eye Study OphthalmologyAugust 2004
Socioeconomic Risk Factors for Breast Cancer: Distinguishing Individual- and Community-Level Effects EpidemiologyJuly 2004
Racial Differences in the Cause-Specific Prevalence of Blindness in East BaltimoreNew England Journal of MedicineNovember 1991

Keep up with the pulse of America's Essential Hospitals

Members: Sign up for email updates.