PURPOSE: Disparities in healthcare related to socioeconomic differences have been well documented in adult medicine, but are less characterized in the pediatric population. Each year, more than 75,000 children are treated for sepsis in the United States, with up to 20% resulting in death. We performed this study to test the hypothesis that socioeconomic status is associated with the risk of mortality among children treated for sepsis in pediatric intensive care units (PICU). METHODS: This was a retrospective cross-sectional study of 48 children’s hospitals from 2010 through 2016 using the Pediatric Health Information System database. We included all visits by children ≤ 21 years old with APR-DRG diagnosis codes of septicemia and disseminated infections that resulted in PICU admission. We measured the bivariable association of sociodemographic factors (insurance status and median household income for the patient’s zip code) with mortality. We performed multivariable logistic regression to measure the effect of socioeconomic status on mortality after adjustment for age, gender, race/ethnicity, illness severity, and presence of complex chronic condition with generalized estimating equations to account for clustering by hospital. RESULTS: During the study period, there were 14,276 PICU patients with sepsis. The median (IQR) age was 7.8 (1.5-14.8) years. Half (49.6%) identified as white, non-Hispanic. The majority (58.4%) were publicly insured and 1.5% were uninsured. Among the entire population, mortality rate from sepsis was 6.8 per 100 children. Race/ethnicity was not associated with mortality risk. After adjusting for age, race/ethnicity, household income, presence of a complex condition, and severity of illness, non-privately insured children had increased odds of mortality when compared to privately insured children (public: aOR 1.3; 95% CI 1.1, 1.5; uninsured: aOR 2.3; 95% CI 1.3, 4.1). Similarly, children who lived in zip codes with the lowest quartile of annual household income had higher mortality rates than children living in zip codes with the highest quartile of annual household income(aOR 1.2 95% CI 1.0, 1.5). CONCLUSIONS: These data suggest potential disparities in sepsis mortality in children based on socioeconomic differences and insurance status. Further research is warranted to understand why such disparities exist.
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Section on Critical Care| August 01 2019
Socioeconomic Disparities Associated with Sepsis Mortality
Anireddy R. Reddy, MD;
Monika Goyal, MD, MSCE;
James Chamberlain, MD;
Pediatrics (2019) 144 (2_MeetingAbstract): 404.
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Anireddy R. Reddy, Monika Goyal, James Chamberlain, Gia Badolato; Socioeconomic Disparities Associated with Sepsis Mortality. Pediatrics August 2019; 144 (2_MeetingAbstract): 404. 10.1542/peds.144.2MA5.404
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