37-The Association of Socioeconomic Status and Pediatric Sepsis Outcomes
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Pediatrics, Sepsis, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Kayla Phelps


Introduction/Hypothesis: Among adults with severe sepsis, socioeconomic status (SES) is associated with significant health disparities, including higher mortality and readmission rate. In children, the association between SES and adverse health outcomes is known for bronchiolitis, asthma, and neonatal bacterial infections. However, the association of a child's SES on sepsis outcomes is not well understood, highlighting a knowledge gap for possible clinical and population based interventions. We hypothesize that children with lower SES will have higher mortality and longer length of stay (LOS) compared to their peers with higher SES.

Methods: Using the Nationwide Readmissions Database (2016/17), pediatric severe sepsis hospitalizations were identified by ICD-10 codes for severe sepsis/septic shock or by concurrent codes for sepsis and organ failure. ZIP Code related income quartiles estimate median household income of residents in the patient's ZIP Code, ranging from the lowest income quartile (Q1) (income $1 - 43,999) to the highest income quartile (Q4) (income $74,000+). We compared the rate of in-hospital mortality and LOS between income quartiles using chi-square analysis and ANOVA, respectively. Next, we compared outcomes between the lowest and highest income quartiles using chi-square and Wilcoxon rank sum.

Results: Among 1,048,470 pediatric hospitalization, we identified 10,130 (0.96%) severe sepsis hospitalization. There was no association between the rate of severe sepsis hospitalizations and income quartile. Overall, 851 (8.4%) of severe sepsis patients died during hospitalization. There were 3,140 (30.1%) hospitalizations in Q1, 2,759 (27.2%) in Q2, 2,357 (23.3%) in Q3, and 1,736 (17.1%) in Q4. Children in Q1 were younger (median age 11 years [IQR 4-16] vs 13 years [IQR 6-17] in Q4) and more likely to have Medicaid Insurance compared to peers in Q4 (73.8% vs 35.3%) (p<0.001). There was no association between income quartile and mortality (p=0.319). Of sepsis survivors, patients in Q1 had a longer LOS compared to those in Q4 (Median 9 days [IQR 5-20] vs 8 days [IQR 4-17]; p<0.001).

Conclusions: In children with severe sepsis, there was no difference in mortality rate by income quartile. However, children living in the lowest ZIP Code related income quartile had longer LOS compared to those in the highest.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Sepsis
Knowledge Level Advanced
Membership Level Select
Tag Scoring Systems
Tag Monitoring
Year 2021
socioeconomic status
pediatric sepsis
length of stay
income neighborhoods
health disparities


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