Journal of General Internal Medicine

, Volume 28, Issue 2, pp 269–282 | Cite as

Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

  • Linda Calvillo–KingEmail author
  • Danielle Arnold
  • Kathryn J. Eubank
  • Matthew Lo
  • Pete Yunyongying
  • Heather Stieglitz
  • Ethan A. Halm



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.


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.


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.


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.


readmission mortality systematic review heart failure community acquired pneumonia 




Dr. Calvillo–King was supported by a Diversity Supplement from the National Institute of Neurological Diseases and Stroke, and NIH CTSA (5UL1 RR024982-05). Dr. Halm was supported in part by NIH (5TL1 RR0249884-05), and NIH CTSA (5UL1 RR024982-05).

Prior Presentations

This study was presented as a poster at the Society of General Internal Medicine 34th Annual Meeting, May 6, 2011, Phoenix, Arizona and at the Academy Health Annual Research Meeting, June 13, 2011, Seattle, Washington.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Financial Disclosure



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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Linda Calvillo–King
    • 1
    Email author
  • Danielle Arnold
    • 1
  • Kathryn J. Eubank
    • 1
  • Matthew Lo
    • 1
  • Pete Yunyongying
    • 1
  • Heather Stieglitz
    • 1
  • Ethan A. Halm
    • 1
    • 2
  1. 1.Division of General Internal MedicineUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of Clinical SciencesUniversity of Texas Southwestern Medical Center at DallasDallasUSA

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