The Distressed Community Index is not associated with mortality in critically ill patients with sepsis

Author(s):
Chloe Williams; Jon Wisler; Megan Ireland; Anahita Jalilvand

Background:

Over 1,000,000 people are affected by sepsis annually, with many requiring ICU admission. The impact of socioeconomic factors on outcomes following sepsis is unclear. The distressed communities index (DCI) is a composite score based on unemployment, education level, poverty rate, median income, business growth, and housing vacancies, which attempts to quantify socioeconomic well-being by zip code. Therefore, the primary objective of this study was to evaluate the association between DCI and mortality in patients admitted to the surgical ICU (SICU) with sepsis.

Hypothesis:

Community distress is predictive of worse outcomes in patients with sepsis.

Methods:

We conducted a retrospective analysis of institutional data for patients diagnosed with sepsis or septic shock (SOFA2) admitted to the SICU. High or “distressed” communities were defined as a DCI in the top quartile of our cohort (n=331), while low or non-distressed DCIs were below the median (n=661). Baseline demographic and clinical characteristics were compared based on this stratification. Primary outcomes included in-hospital and 90-day mortality, incidence of respiratory or renal failure, and discharge disposition. Multivariate regression analyses were performed to identify independent variables associated with outcomes. A p <0.05 was considered statistically significant.

Results:

Overall 90-day mortality was 28.6% (n=284). The low DCI cohort was older (61.214.9 vs. 57.216.9 years), more likely to be Non-Hispanic White (90% vs. 76%), more likely to be transferred, and less likely to have significant liver disease or COPD. Initial SOFA scores were comparable (5 (4-8) vs 6 (4-8), p=0.75), as were rates of vasopressor use (38% vs 36%, p=0.54). Incidence of respiratory and renal failure, and discharge disposition were equivalent between groups. Low DCI patients had comparable in-house (24% vs 23%) and 90-day mortality (28% vs 30.2%). After regression analyses, DCI was not a significant predictor of mortality in this cohort.

Conclusions:

Socioeconomic status has been consistently championed for inclusion when constructing risk models, evaluating resource utilization, comparing hospitals, and determining patient management. Using a robust index of community distress, we did not find an association between DCI severity and sepsis mortality, despite contrasting evidence in other disease processes. While the absence of DCI-related associations observed herein merits further investigation, this suggests that bundled care in sepsis management may mitigate healthcare disparities.