Association of Socioeconomic Status and Pediatric Sepsis Outcomes

Researchers analyzed data from more than 1 million children who were hospitalized in 2016 and 2017 using the Nationwide Readmissions Database, identifying 10,130 children who had severe sepsis. Researchers divided the children into four quartiles based on average household income in that ZIP code and compared outcomes. They determined that 3140 children (30.1%) were from the lowest-income quartile and 1736 children (17.1%) were from the highest-income quartile, reflecting the fact that, in the United States, more children live in low-income than high-income neighborhoods. Overall, 851 children (8.4%) died of sepsis while hospitalized, although there was no association between death rates and income level. However, there was a difference in length of stay, with the children from the lowest-income ZIP codes spending a median of nine days in the hospital versus eight days for the children from the highest-income ZIP codes.
 

For guidelines and tools on sepsis management, visit the Surviving Sepsis Campaign.

 

“While our study has identified a link between where a child lives and the length of stay during sepsis hospitalizations, additional research is needed to understand why this might be the case. However, some possibilities include differences between the hospitals, care delivered, or if something is keeping them from being ready to go home after they recover,” said Kayla Phelps, MD, MPH, lead author of the study and a pediatric care fellow at C.S. Mott Children’s Hospital in Ann Arbor, Michigan. “We hope to share these results with medical, public health, and community groups so they can continue to work to address this disparity. It’s important to provide accessible, culturally appropriate, affordable healthcare to all children. Also, policy interventions that work toward a more equitable and just society as well as access to clean water, healthy foods, and safe spaces to play can help decrease these disparities.”
 
The researchers also determined that, compared with children in the highest-income ZIP codes, those in the lowest-income ZIP codes were younger (age 11 years vs. 13 years), and more likely to have Medicaid insurance (73.8% vs. 35.3%).
 
“More research should be done to minimize health disparities faced by children in their communities and to ensure that high-quality care is delivered to all children regardless of where they live,” said Dr. Phelps.
 
Similar findings are highlighted in the article Disparities in Sepsis Management and Outcomes published in the Spring 2020 issue of Critical Connections.
 
Other SCCM resources on disparities in critical care:

• The Elephant in the Room: The Many Impacts of Bias