Socioeconomic Impact on Sepsis


  • Socioeconomic variables, beyond the control of patients and providers can impact the outcomes of sepsis patients.

  • Larger data sets are needed to confirm the full impact of socioeconomic factors on sepsis mortality and hospital readmission rates.

  • Further investigation to better understand socioeconomic variables on their influence to sepsis mortality is warranted.


  • Clinical outcomes are influences by a variety of factors including:

    • Demographics

    • Medical comorbiditiesIllness severity

    • Healthcare access

    • Hospital characteristics (i.e. teaching status, size, ownership, outcome metrics).

  • Social and environmental factors beyond the control of the patient plays a major role in driving health outcomes and can result in marked variations in health outcomes.

  • The most recent Surviving Sepsis Campaign recommendations (2021) include a best practice statement to screen for economic and social support as well as sepsis education for families and patients as they return home.

  • Key social determinants impacting health are illustrated in the figure:

Socioeconomic Determinants in Sepsis

  • Evaluating the effect of socioeconomic factors in sepsis has only recently been addressed.

  • It is unclear how social determinants effects the development and/or natural course of sepsis.

  • Key differences between studies are the definition used which demographically constitute a homogeneous community. Various methods used include:

    • Zip codes

    • County/City level data

    • Employment status

    • Insurance status

    • Education level

    • Age disparities

    • Area Deprivation Index (ADI – geospatial index of socioeconomic disadvantage)

Bloodstream Infections

  • Although bloodstream infections occur in 0.5 to 1.3% of hospitalized patients, they are common causes of ICU admission with mortality rates from 20-40%.

  • 14,597 patients had a bloodstream infection rate of 16.7% with 90 day mortality rates of 30.9% (Mendu et al Crit Care Med 2012:40:1427).

  • Neighborhood poverty rate was a strong predictor of risk of bloodstream infections.


  • Lower income neighborhoods have a higher rate of sepsis attributable mortality than higher income neighborhoods (3.65 vs 2.80 per 10,000 persons, P=0.02)

  • 55 neighborhoods in Baltimore City with median income (2015) $38,660. Low income at 25th percentile = $32,530. High income above 75th percentile $54,480.

  • Lusk et al: 1,486,683 Medicare claims 2016-2019 admissions with DRG sepsis codes.

  • Neighborhood socioeconomic status via Area Deprivation Index (ADI).ADI is a measure of socioeconomic indicators (income, housing, employment, education).ADI scored from 0 (least deprived) to 100 (most deprived)

  • Sepsis mortality correlated with ADI

Hospital Readmission

  • ICD-10 codes for sepsis in 531 patients meeting Sepsis-3 definition


  • Socioeconomic factors are linked to sepsis outcomes in critical care.

  • Lower socioeconomic factors with sepsis have been associated with bloodstream infections, higher mortality rates as well as higher readmission rates.

  • Further investigation to better understand socioeconomic variables on their influence to sepsis mortality is warranted.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (, or video chat.