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Children with severe sepsis: relationship between community level income and morbidity and mortality

Kayla B Phelps1, Acham Gebremariam2, Erica Andrist3

  • 1Divison of Pediatric Critical Care Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA. kaylabphelps@gmail.com.

Pediatric Research
|February 22, 2023
PubMed

Insights

Children with severe sepsis in lower income areas may experience longer hospital stays, but income level did not significantly impact mortality or readmission rates. Further research with more precise socioeconomic status metrics is needed to understand disparities.

Area of Science:

  • Pediatric critical care
  • Health services research
  • Socioeconomic determinants of health

Background:

  • Health disparities in pediatric severe sepsis outcomes are not well understood.
  • Socioeconomic status (SES) indicators are crucial for identifying disparities in healthcare.
  • Severe sepsis is a significant cause of morbidity and mortality in critically ill children.

Purpose of the Study:

  • To investigate the relationship between socioeconomic status and outcomes in pediatric severe sepsis.
  • To analyze disparities in mortality, hospital length of stay (LOS), and readmission rates based on income.
  • To determine if income level influences severe sepsis outcomes in children.

Main Methods:

  • Analysis of Nationwide Readmissions Database (2016-2018) for pediatric severe sepsis hospitalizations (0-18 years).
  • Primary exposure: median household income by ZIP Code, categorized into quartiles (Q1-Q4).
  • Comparison of mortality, LOS, and readmission rates across income quartiles.

Main Results:

  • 15,214 pediatric severe sepsis hospitalizations were identified.
  • No significant differences in mortality or readmission rates were observed across income quartiles.
  • Survivors in the lowest income quartile (Q1) had a 2-day longer LOS compared to the highest income quartile (Q4) (p < 0.0001), but this was not significant after multivariable adjustment.

Conclusions:

  • While unadjusted analysis showed longer LOS for children in lower income areas, multivariable analysis suggests income quartile is not a significant driver of this difference.
  • More sensitive metrics of socioeconomic status are required to accurately identify and understand health disparities in pediatric severe sepsis.
  • Further research is needed to elucidate the complex interplay between SES and severe sepsis outcomes in children.
Abstract

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