Socioeconomic factors associated with increased mortality in adults with sepsis or septic shock

This systematic review and meta-analysis examined the association between socioeconomic position indicators and mortality in adults with sepsis or septic shock. The analysis synthesized data from 13 observational studies, encompassing a total of 3,951,677 patients. The specific study settings were not reported in the provided data. The population consisted exclusively of adults diagnosed with sepsis and/or septic shock, though no further demographic breakdown was available.

The intervention or exposure in this analysis was socioeconomic position, measured through five distinct indicators: lack of private insurance, lower neighborhood socioeconomic status, lower income, less education, and unemployment. There was no single comparator group; rather, each indicator represented a comparison between those with and without the specific socioeconomic disadvantage. The analysis examined the association of these indicators with mortality outcomes, though the specific measurement protocols for these socioeconomic variables were not detailed.

The primary outcome was mortality, assessed as short-term mortality (though the exact timeframe was not further specified). For lack of private insurance, the adjusted odds ratio (aOR) was 1.34 (95% CI, 1.19-1.51), indicating a statistically significant association with increased mortality. For lower neighborhood socioeconomic status, the aOR was 1.35 (95% CI, 1.29-1.41), also showing a probable association with increased mortality. For lower income, two effect measures were reported: an aOR of 1.06 (95% CI, 1.01-1.11) and an adjusted hazard ratio (aHR) of 1.51 (95% CI, 1.01-2.25), both suggesting a probable association with increased mortality. For less education, the aOR was 1.33 (95% CI, 1.14-1.55), indicating a possible association. For unemployment, the aOR was 1.91 (95% CI, 1.00-3.63), suggesting a possible association with increased mortality, though the confidence interval includes 1.00. Absolute numbers for these outcomes were not reported.

No specific secondary outcomes were listed in the provided data. The analysis focused solely on the mortality outcome across the different socioeconomic indicators.

Safety and tolerability findings were not reported in this meta-analysis, as the study examined observational associations rather than an interventional treatment with associated adverse events. The analysis did not provide data on adverse events, serious adverse events, discontinuations, or tolerability profiles related to the socioeconomic exposures.

This meta-analysis contributes to a growing body of literature documenting health disparities in critical care outcomes. Prior landmark studies in sepsis have primarily focused on biological and clinical risk factors, treatment protocols, and hospital-level quality measures. This analysis systematically quantifies the association of structural social determinants with a hard clinical endpoint, adding a crucial dimension to understanding sepsis outcomes that complements traditional clinical research.

Key methodological limitations stem from the nature of the included studies. All 13 source studies were observational, meaning they can demonstrate association but cannot establish causation between socioeconomic factors and mortality. The certainty of the evidence varied considerably across indicators: it was rated as high for lack of private insurance, moderate for lower neighborhood socioeconomic status and lower income, and low for less education and unemployment. This variation limits the strength of conclusions for some indicators. Other potential biases common to observational research, such as residual confounding, measurement error in defining socioeconomic status, and heterogeneity in how sepsis was diagnosed across studies, were not detailed but likely exist.

The clinical implications are significant for practice decisions. These findings underscore that patient outcomes in sepsis are linked to factors beyond the hospital walls and immediate clinical care. They support the argument for routinely collecting equity-relevant variables in sepsis registries and clinical research to better understand and address disparities. For clinicians, this reinforces the importance of considering a patient's social context during care planning and discharge coordination. The analysis suggests that interventions targeting modifiable socioeconomic factors, such as improving insurance coverage or neighborhood resources, could potentially help improve sepsis outcomes and reduce disparities, though such interventions would require policy-level changes.

Several important questions remain unanswered. The exact mechanisms linking each socioeconomic indicator to increased mortality—whether through differences in access to care, quality of care received, baseline health status, or post-discharge support—are not elucidated by this associative study. The analysis did not explore whether these associations vary by sepsis severity, patient age, race, ethnicity, or geographic region. Furthermore, the effectiveness of specific hospital-based or community-based interventions designed to mitigate these disparities was not assessed. The long-term impact of socioeconomic position on outcomes beyond short-term mortality also remains unknown.