Socioeconomic Status and Sepsis Outcomes

People with lower socioeconomic status (SES) who develop sepsis are more likely to be sicker than those with higher SES, according to a recently published report. In response, the Sepsis Alliance Institute invited one of the report’s authors to present a webinar, called Closing the Gap: Sepsis Care in Underserved Communities.

Sepsis deaths have been decreasing over time, according to Emi Minejima, PharmD, and Annie Wong-Beringer, PharmD, authors of a research paper called Impact of Socioeconomic Status and Race on Sepsis Epidemiology and Outcomes. “However, sepsis incidence disproportionally affects individuals with low socioeconomic status (SES) and increases their risk of poor outcome,” they wrote. In other words, socioeconomic status and sepsis outcomes are heavily related.

Socioeconomic status is complex, because it involves a mix of factors. These include education level, income, place of residence, race, and occupation. These factors also may contribute to a person’s health profile and access to quality healthcare.

Underlying Health Conditions and Access to Care

Underlying health conditions, called comorbidities, are much more common among people in the lowest SES populations compared with those in the highest SES populations, the authors said. This means those in lower-SES populations often start out sicker and may be more prone to contracting infections than their higher SES counterparts. These comorbidities include diabetes, hypertension, chronic kidney disease, and obesity, among others. Chronic conditions like these are known to be related to poorer outcomes when combined with infections and sepsis.

Meanwhile, SES factors may also influence how people access care when they need it. Geographical obstacles, such as living far from a hospital, may make it too difficult to seek help. Lack of insurance is another significant barrier. Not having insurance or having inadequate insurance may cause people to wait before seeking treatment, or they may not at all.

The authors referred to a California study that reported uninsured individuals with sepsis were more likely to arrive at the hospital already experiencing organ dysfunction – one more organs not working properly. Since effective sepsis care is about timely recognition and treatment, any delay in seeking medical care, for any reason, can be perilous.

It is important to note that SES is not related just to sepsis. It is also related to hospital readmissions. Those in the lower SES have a higher risk of having to return to the hospital with a recurring or new infection, and sepsis.

Targeted Interventions Needed

In Minejima’s and Wong-Beringer’s view, “targeted interventions are needed for these patients, focusing on both prevention strategies before sepsis onset and increased support at discharge for prevention of hospital readmission.” Sepsis Alliance, the first and leading sepsis organization in the U.S., supports this and understands that decreasing the likelihood of low-socioeconomic status individuals developing sepsis in the first place is of the utmost importance. Expanding quick access to care for individuals who do become sick, and targeting strategies for effective recovery in the aftermath of sepsis treatment is essential too.

Improving sepsis outcomes in low-SES populations aligns with Sepsis Alliance’s ongoing efforts in the sepsis and equity sphere. The organization’s pledge to increase equity, diversity, and inclusion in the sepsis care community is available here.

For more information about the disproportionate incidence of sepsis in low-SES communities and communities of color, download the Sepsis and Health Equity fact sheet.

You can take a course with Emi Minejima on the Sepsis Alliance Institute this Thursday! Click here to register for Closing the Gap: Sepsis Care in Underserved Communities. This free live webinar will explore the relationship between SES and sepsis outcomes, including how to minimize disparities in clinical practice.  A recording will be available for those unable to attend the live presentation.