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
