Area Deprivation Index (ADI) Predicts Increased 90-day Mortality in Critically Ill Patients with Sepsis

Author(s):
Whitney Kellett; Anahita Jalilvand; Holly Baselice; Megan Ireland; Wendy Wahl; Jon Wisler

Background:

Measures of community distress show mixed results regarding their association with health outcomes in critically ill patients.   Area Deprivation Index (ADI) has emerged as a more clinically-relevant socioeconomic metric. While the ADI has been shown to improve surgical risk adjustment, its association with mortality, particularly in septic patients, remains unclear. The primary objective of this study was to evaluate the association between ADI and mortality in patients admitted to the surgical ICU (SICU) with sepsis.

Hypothesis:

We hypothesized that higher area deprivation would be associated with higher cumulative 90-day mortality in surgical patients with sepsis.

Methods:

All admissions (N=1401) for sepsis (SOFA ≥ 2) between 2014-2019 were reviewed.  Clinical, demographic characteristics, and ADI scores were obtained for each patient and classified into “high distress” (ADI≥85th percentile, n=400) and “control distress” (ADI<85th percentile, n=976).  The primary outcomes were in-hospital and 90-day mortality.

Results:

The high ADI cohort was younger (58.5 ± 15.4 vs 60.8 ± 15.2, p=0.01) and more likely to be African American (24% vs 10%, p <0.005), transferred from an outside facility (52.0% vs 44.8%, p=0.015), and have COPD (26.5% vs 19.0%, p=0.002). While admission SOFA scores were comparable between groups, the high ADI cohort presented with higher rates of NSTIs (17.5% vs 10.9%, p = 0.006) and were more likely to suffer renal failure (20.3% vs 15.3%, p = 0.02). Compared to the control cohort, high ADI patients had increased in-house (27.3% vs 21.6%, p=0.025) and 90-day mortality (35% vs 28.9%, p=0.03). After adjusting for baseline characteristics and sepsis presentation, high ADI was associated with increased odds of 90-day mortality (OR 1.39 ± 0.24, 95th CI: 1.09-2.07).

Conclusions:

High ADI was an independent predictor of 90-day mortality in critically ill surgical patients with sepsis. This is one of the first studies to demonstrate an association between area deprivation and mortality in septic patients. Future studies should focus on identifying mitigating interventions to improve outcomes in the high ADI population.