BMJ open · 2025
Impact of social determinants of health on sepsis outcomes: a retrospective study of a single centre in the USA.
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Nyelele Mwembezi A, Estela Karen, Jagneaux Tonya, Ikuma Laura H, Knapp Gerald M
Аннотация
OBJECTIVES: Social determinants of health (SDOH) factors are known to influence patient outcomes, but their effect on sepsis remains insufficiently studied. This research aims to investigate the relationship between SDOH factors and sepsis outcomes, highlighting opportunities to reduce health disparities and enhance patient care.
DESIGN: Retrospective study.
SETTING: Level I trauma centre in Baton Rouge, Louisiana, USA.
PARTICIPANTS: Patients with sepsis aged 18-89 years. Patients discharged or transferred to hospice were excluded to prevent bias and misinterpretation of the findings.
MAIN EXPOSURE MEASURES: Social Vulnerability Index (SVI), the Gini Index and the average distance to the nearest urgent care, emergency department and clinic.
MAIN OUTCOME MEASURES: In-hospital mortality, 30-day readmission and hospital length of stay (LOS).
METHODS: χ2 tests, Mann-Whitney U tests and Cox regression.
RESULTS: Distance from urgent care is significantly associated with mortality (4.14 vs 3.24 miles, p<0.001). Higher SVI is significantly associated with longer LOS (HR=0.846, 95% CI 0.743 to 0.963, p=0.011). Distance from urgent care is also significantly associated with a longer LOS (HR=0.991, 95% CI 0.986 to 0.996, p=0.001).
CONCLUSION: Mortality and LOS are closely linked to proximity to urgent care, while high SVI is notably associated with longer LOS. These findings highlight the significant impact of SDOH factors on sepsis outcomes and underscore the need for targeted interventions to address disparities in healthcare access and contextual health practices.
DESIGN: Retrospective study.
SETTING: Level I trauma centre in Baton Rouge, Louisiana, USA.
PARTICIPANTS: Patients with sepsis aged 18-89 years. Patients discharged or transferred to hospice were excluded to prevent bias and misinterpretation of the findings.
MAIN EXPOSURE MEASURES: Social Vulnerability Index (SVI), the Gini Index and the average distance to the nearest urgent care, emergency department and clinic.
MAIN OUTCOME MEASURES: In-hospital mortality, 30-day readmission and hospital length of stay (LOS).
METHODS: χ2 tests, Mann-Whitney U tests and Cox regression.
RESULTS: Distance from urgent care is significantly associated with mortality (4.14 vs 3.24 miles, p<0.001). Higher SVI is significantly associated with longer LOS (HR=0.846, 95% CI 0.743 to 0.963, p=0.011). Distance from urgent care is also significantly associated with a longer LOS (HR=0.991, 95% CI 0.986 to 0.996, p=0.001).
CONCLUSION: Mortality and LOS are closely linked to proximity to urgent care, while high SVI is notably associated with longer LOS. These findings highlight the significant impact of SDOH factors on sepsis outcomes and underscore the need for targeted interventions to address disparities in healthcare access and contextual health practices.