Kids With Sepsis From Poor Neighborhoods Have Longer Hospital Stays

By Megan Brooks

February 08, 2021

NEW YORK (Reuters Health) - Children being treated for sepsis remain in the hospital longer if they come from low-income neighborhoods, although it's not entirely clear why, a large U.S. study shows.

According to the Surviving Sepsis Campaign, every year about 1.2 million children worldwide develop sepsis, which can cause organ damage and sometimes death.

"The literature is robust around adult sepsis disparities" in showing that lower socioeconomic status (SES) is associated with increased 30-day mortality and readmission rates, lead author Dr. Kayla Bronder Phelps reported at the Society of Critical Care Medicine (SCCM) virtual Critical Care Congress.

"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," Dr. Phelps, a pediatric-care fellow at C.S. Mott Children's Hospital, in Ann Arbor, Michigan, said in her conference abstract.

To help answer this question, the researchers analyzed data on more than 1 million children hospitalized in 2016 and 2017 using the Nationwide Readmissions Database.

They identified more than 10,000 children (0.96%) with severe-sepsis hospitalization and divided them into four quartiles based on median household income in their zip code.

Thirty percent of these children were from the lowest-income quartile (Q1: income $1 to $43,999) and 17% were from the highest-income quartile (Q4: income $74,000+).

Overall, 851 children (8.4%) died of sepsis during their hospital stay. There was no association between income level and mortality (P=0.319). However, children from the lowest income zip codes had a longer hospital stay than peers from the highest-income zip codes (median, 9 days vs. 8 days; P<0.001).

Compared to children in the highest-income zip codes, those in the lowest-income zip codes were younger (median, 11 vs. 13 years), and more likely to have Medicaid insurance (734% vs. 35%).

Reached for comment, Dr. Scott Weiss, a member of the Society of Critical Care Medicine, said the study "provides important data to look at the impact of income and socioeconomic status on outcomes for children with sepsis. The strengths of the study are that it's very large and the methodology appears to be rigorous, so that's helpful."

Dr. Weiss said what's interesting is that the researchers probably set out to test the hypothesis that being from a lower income zip code is associated with worse outcomes. "Other than a slightly longer length of stay, there was not a mortality difference," Dr. Weiss, a pediatric intensivist at Children's Hospital of Philadelphia, said by phone.

He also said it's possible that Medicaid insurance, which was more common in the lowest income quartile, provided some "protective influence, compared to children from higher income quartiles where access to Medicaid may be more limited and under-insurance or lack of insurance may be more of a problem. There are some data that having Medicaid actually is associated with better outcomes than having no insurance at all."

Dr. Weiss said it's also hard to interpret the clinical significance of a one-day longer hospital stay in the lowest income group.

"I think it's easy to jump to conclusions such as treatment was different so they didn't get better as fast or they didn't have the same access to post-hospital care. But right now, that is really speculative to attribute their findings to any of those causes. However, I do think it raises concern and is something that needs to be looked at in a way that allows you to get at those additional confounding factors."

SOURCE: Society of Critical Care Medicine Critical Care Congress, presented February 1, 2021.