title: Association of Household Income Level and In-Hospital Mortality in Patients With Sepsis: A Nationwide Retrospective Cohort Analysis.
abstract: OBJECTIVE
  Associations between low socioeconomic status (SES) and poor health outcomes have been demonstrated in a variety of conditions. However, the relationship in patients with sepsis is not well described. We investigated the association of lower household income with in-hospital mortality in patients with sepsis across the United States.
  
  
  METHODS
  Retrospective nationwide cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2011. Patients aged 18 years or older with sepsis were included. Socioeconomic status was approximated by the median household income of the zip code in which the patient resided. Multivariate logistic modeling incorporating a validated illness severity score for sepsis in administrative data was performed.
  
  
  RESULTS
  A total of 8 023 590 admissions from the 2011 NIS were examined. A total of 671 858 patients with sepsis were included in the analysis. The lowest income residents compared to the highest were younger (66.9 years, standard deviation [SD] = 16.5 vs 71.4 years, SD = 16.1, P < .01), more likely to be female (53.5% vs 51.9%, P < .01), less likely to be white (54.6% vs 76.6%, P < .01), as well as less likely to have health insurance coverage (92.8% vs 95.9%, P < .01). After controlling for severity of sepsis, residing in the lowest income quartile compared to the highest quartile was associated with a higher risk of mortality (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.03-1.08, P < .01). There was no association seen between the second (OR: 1.02, 95% CI: 0.99-1.05, P = .14) and third (OR: 0.99, 95% CI: 0.97-1.01, P = .40) quartiles compared to the highest.
  
  
  CONCLUSIONS
  After adjustment for severity of illness, patients with sepsis who live in the lowest median income quartile had a higher risk of mortality compared to residents of the highest income quartile. The association between SES and mortality in sepsis warrants further investigation with more comprehensive measures of SES.
authors.affiliation: 1 Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.|2 Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.|3 Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada.|4 Division of Critical Care Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Barret
authors.initials: B
authors.lastname: Rush
authors.affiliation: 1 Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Katie
authors.initials: K
authors.lastname: Wiskar
authors.affiliation: 5 Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
authors.affiliation: 3 Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada.|4 Division of Critical Care Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Walley
authors.affiliation: 3 Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada.|4 Division of Critical Care Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
authors.affiliation: 1 Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.|6 Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
authors.forename: Robert C
authors.initials: RC
authors.lastname: McDermid
authors.affiliation: 3 Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada.|4 Division of Critical Care Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John H
authors.initials: JH
authors.lastname: Boyd
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality*; D012720:Severity of Illness Index; D012923:Social Class; D014481:United States / Q000453:epidemiology
keywords: epidemiology; hospital mortality; outcomes; sepsis