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J Pediatr Intensive Care 2022; 11(02): 147-152
DOI: 10.1055/s-0040-1721730
Original Article

Disparities Associated with Sepsis Mortality in Critically Ill Children

Anireddy R. Reddy
1   Department of Pediatrics, Children’s National Medical Center, Washington, District of Columbia, United States
,
Gia M. Badolato
2   Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
,
James M. Chamberlain
2   Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
,
Monika K. Goyal
2   Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
› Author Affiliations Funding None.
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Abstract

Disparities in health care related to socioeconomic status and race/ethnicity are well documented in adult and neonatal sepsis, but they are less characterized in the critically ill pediatric population. This study investigated whether socioeconomic status and/or race/ethnicity is associated with mortality among children treated for sepsis in the pediatric intensive care unit (PICU). A retrospective cohort study was conducted using information from 48 children's hospitals included in the Pediatric Health Information System database. We included visits by children ≤ 21 years with All Patients Refined Diagnosis-Related Groups (APR-DRG) diagnosis codes of septicemia and disseminated infections that resulted in PICU admission from 2010 to 2016. Multivariable logistic regression was used to measure the effect of race/ethnicity and socioeconomic status (insurance status and median household income for zip code) on mortality after adjustment for age, gender, illness severity, and presence of complex chronic condition. Among the 14,276 patients with sepsis, the mortality rate was 6.8%. In multivariable analysis, socioeconomic status, but not race/ethnicity, was associated with mortality. In comparison to privately insured children, nonprivately insured children had increased odds of mortality (public: adjusted odds ratio [aOR]: 1.2 [1.0, 1.5]; uninsured: aOR: 2.1 [1.2, 3.7]). Similarly, children living in zip codes with the lowest quartile of annual household income had higher odds of mortality than those in the highest quartile (aOR: 1.5 [1.0, 2.2]). These data suggest the presence of socioeconomic, but not racial/ethnic, disparities in mortality among children treated for sepsis. Further research is warranted to understand why such differences exist and how they may be addressed.

Keywords

pediatrics - intensive care - socioeconomic status - race - health disparities

Note

The study was completed while the author was affiliated with Children's National; however, the current corresponding address is Children's Hospital of Philadelphia.




Publication History

Received: 06 September 2020

Accepted: 04 November 2020

Article published online:
26 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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