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

Pediatric Research volume 94, pages 837–844 (2023)Cite this article

Abstract

Background

Health disparities surrounding pediatric severe sepsis outcomes remains unclear. We aimed to measure the relationship between indicators of socioeconomic status and mortality, hospital length of stay (LOS), and readmission rates among children hospitalized with severe sepsis.

Methods

Children 0–18 years old, hospitalized with severe sepsis in the Nationwide Readmissions Database (2016–2018) were included. The primary exposure was median household income by ZIP Code of residence, divided into quartiles.

Results

We identified 15,214 index pediatric severe sepsis hospitalizations. There was no difference in hospital mortality rate or readmission rate across income quartiles. Among survivors, patients in Q1 (lowest income) had a 2 day longer LOS compared to those in Q4 (Median 10 days [IQR 4–21] vs 8 days [IQR 4–18]; p < 0.0001). However, there was no difference after adjusting for multiple covariates.

Conclusions

Children living in Q1 had a 2 day longer LOS versus their peers in Q4. This was not significant on multivariable analysis, suggesting income quartile is not driving this difference. As pediatric severe sepsis remains an important source of morbidity and mortality in critically ill children, more sensitive metrics of socioeconomic status may better elucidate any disparities.

Impact

  • Children with severe sepsis living in the lowest income ZIP Codes may have longer hospital stays compared to peers in higher income communities.

  • More precise metrics of socioeconomic status are needed to better understand health disparities in pediatric severe sepsis.

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Fig. 1: Study Cohort.

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Data availability

The datasets analyzed during the current study are available in the Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project. https://www.hcup-us.ahrq.gov/nrdoverview.jsp

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Acknowledgements

The authors would like to thank Mary Dahmer for her critical review of this manuscript.

Funding

Funding for this project was provided by the University of Michigan Department of Pediatrics Diversity, Equity and Inclusion Research Trainee Grant. No extramural funding sources were used.

Author information

Authors and Affiliations

  1. Divison of Pediatric Critical Care Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA

    Kayla B. Phelps

  2. Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    Acham Gebremariam, Ryan P. Barbaro, Gary L. Freed & Erin F. Carlton

  3. Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA

    Erica Andrist, Ryan P. Barbaro & Erin F. Carlton

  4. Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA

    Gary L. Freed

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Contributions

Each author has met the Pediatric Research authorship requirements. K.B.P., A.G., and E.F.C made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. E.A., R.P.B., and G.L.F. helped in drafting and revising the article. All authors gave final approval of the version to be published.

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Correspondence to Kayla B. Phelps.

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Phelps, K.B., Gebremariam, A., Andrist, E. et al. Children with severe sepsis: relationship between community level income and morbidity and mortality. Pediatr Res 94, 837–844 (2023). https://doi.org/10.1038/s41390-023-02500-w

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