The Association Between Socioeconomic Position and Mortality in Patients With Sepsis and Septic Shock-A Systematic...

To evaluate the association between socioeconomic position (SEP) and mortality in patients with sepsis or septic shock.

We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to August 11, 2025.

We included English-language observational studies that evaluated the association between SEP indicators and mortality in adults with sepsis and/or septic shock.

Two reviewers independently and in duplicate performed data extraction and risk-of-bias assessment using the Quality in Prognosis Studies tool. We pooled adjusted odds ratios (aORs) or adjusted hazard ratios (aHRs) using random-effects models and assessed certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

We included 13 observational studies involving 3,951,677 patients. Lack of private insurance (aOR, 1.34; 95% CI, 1.19-1.51; high certainty) was associated with increased mortality while lower neighborhood socioeconomic status (aOR, 1.35; 95% CI, 1.29-1.41; moderate certainty) and lower income (aOR, 1.06; 95% CI, 1.01-1.11; aHR, 1.51; 95% CI, 1.01-2.25; moderate certainty) were probably associated with increased mortality. Less education (aOR, 1.33; 95% CI, 1.14-1.55; low certainty) and unemployment (aOR, 1.91; 95% CI, 1.00-3.63; low certainty) may be associated with increased mortality.

We found that several indicators of SEP were associated with increased short-term mortality in patients with sepsis and septic shock. These findings underscore the need for routine collection of equity-relevant variables in sepsis research to inform health policy and support equitable care delivery. Given that some of these variables are potentially modifiable, targeted interventions may help improve outcomes and reduce disparities in disadvantaged populations.