Providers should consider social factors, such as race, gender and whether a person is a nursing home resident when assessing readmission risk among pneumonia and heart failure patients, new research finds.

After analyzing 20 pneumonia-related studies and 52 heart failure studies, investigators at the University of Texas Southwestern Medical Center found that social factors out of a providers’ control often play a role in predicting readmission risk within 30 days of a hospital patient’s discharge. For example, having a low level of education, low income and being unemployed were linked to a higher risk of going back into the hospital among beneficiaries with pneumonia.

Being a nursing home resident also was associated with increased the risk for death and readmission in people with pneumonia, investigators noted. Similarly, they found that among heart-failure patients, people who do not live near hospitals, and those who feel cold in their homes were at an increased risk of dying.

“Different and more intensive follow-up strategies will likely be necessary in these high social-risk patients,” the study authors wrote.

On Oct. 1, the Centers for Medicare & Medicaid Services enacted financial penalties to hospitals with that have high numbers of patients who are readmitted within 30 days of discharge for heart attacks, heart failure and pneumonia.

The study was published recently in the Journal of General Internal Medicine.