Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Feb;28(2):269-82.
doi: 10.1007/s11606-012-2235-x. Epub 2012 Oct 6.

Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review

Linda Calvillo-King  1 , Danielle Arnold, Kathryn J Eubank, Matthew Lo, Pete Yunyongying, Heather Stieglitz, Ethan A Halm
Affiliations

Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review

Linda Calvillo-King et al. J Gen Intern Med. 2013 Feb.

Abstract

Background: Readmission and mortality after hospitalization for community-acquired pneumonia (CAP) and heart failure (HF) are publically reported. This systematic review assessed the impact of social factors on risk of readmission or mortality after hospitalization for CAP and HF-variables outside a hospital's control.

Methods: We searched OVID, PubMed and PSYCHINFO for studies from 1980 to 2012. Eligible articles examined the association between social factors and readmission or mortality in patients hospitalized with CAP or HF. We abstracted data on study characteristics, domains of social factors examined, and presence and magnitude of associations.

Results: Seventy-two articles met inclusion criteria (20 CAP, 52 HF). Most CAP studies evaluated age, gender, and race and found older age and non-White race were associated with worse outcomes. The results for gender were mixed. Few studies assessed higher level social factors, but those examined were often, but inconsistently, significantly associated with readmissions after CAP, including lower education, low income, and unemployment, and with mortality after CAP, including low income. For HF, older age was associated with worse outcomes and results for gender were mixed. Non-Whites had more readmissions after HF but decreased mortality. Again, higher level social factors were less frequently studied, but those examined were often, but inconsistently, significantly associated with readmissions, including low socioeconomic status (Medicaid insurance, low income), living situation (home stability rural address), lack of social support, being unmarried and risk behaviors (smoking, cocaine use and medical/visit non-adherence). Similar findings were observed for factors associated with mortality after HF, along with psychiatric comorbidities, lack of home resources and greater distance to hospital.

Conclusions: A broad range of social factors affect the risk of post-discharge readmission and mortality in CAP and HF. Future research on adverse events after discharge should study social determinants of health.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of systematic review strategy and outcomes.
Figure 2.
Figure 2.
Conceptual model of how social factors may influence readmissions and mortality.
See this image and copyright information in PMC

References

    1. Medicaid CfMa. Publicly reporting risk-standardized, 30-day readmission measures for AMI, HF and PN. http://qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPag.... September 7, 2012.
    1. Kansagara D, Englander H, Salanitro A, et al. Risk prediction models for hospital readmission: a systematic review. JAMA. 2011;306(15):1688–1698. doi: 10.1001/jama.2011.1515. - DOI - PMC - PubMed
    1. Krumholz HM, Wang Y, Mattera JA, et al. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2006;113(13):1693–1701. - PubMed
    1. Bratzler DW, Normand S-LT, Wang Y, et al. An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients. PLoS One. 2011;6(4):e17401. doi: 10.1371/journal.pone.0017401. - DOI - PMC - PubMed
    1. Keenan PS, Normand S-LT, Lin Z, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1(1):29–37. doi: 10.1161/CIRCOUTCOMES.108.802686. - DOI - PubMed

Publication types