The Relationship Between Neighborhood Deprivation and Mortality in a Sepsis Cohort in England

Abstract

Background

Worse health outcomes have been described for patients with sepsis from more deprived neighborhoods, but it is unclear if this disparity gap has narrowed. Moreover, the mechanisms by which neighborhood disadvantage influences sepsis outcomes are not understood fully.

Research Question

What is the trajectory of mortality among patients with sepsis in England across varying levels of neighborhood deprivation, and to what extent do patterns of ICU admission and treatment explain observed differences?

Study Design and Methods

This retrospective observational study using multivariable logistic regression included 519,789 patients older than 16 years admitted to the ICU with sepsis between April 1, 2009, and December 31, 2023, from 304 ICUs of 207 acute hospitals in England. The primary outcome was hospital mortality. The secondary outcomes were direct ICU admission from the emergency department; use of mechanical ventilation, renal replacement therapy, and vasopressor therapy; and decisions to limit life-sustaining therapy.

Results

Mortality improved across all groups of neighborhood deprivation from the baseline period from 2009 through 2011, and was 4.5% lower from 2022 through 2023 in the most deprived and 4.4% lower in the least deprived quartile, with no significant narrowing of the disparity gap over time (P = .833). Direct ICU admission from the emergency department was similar for patients across groups of neighborhood deprivation at baseline and increased similarly over time with no significant between-group difference. The gap in mechanical ventilation, renal placement therapy, and vasopressor use narrowed over time. Mortality trends were driven primarily by within-hospital improvements in care, and only a minor component was attributable to shift of patients from lower-quality to higher-quality hospitals.

Interpretation

Although sepsis mortality has improved across England, a persistent disparity associated with neighborhood deprivation exists. Further investigation is required to evaluate other potential contributory factors to help understand better how living in deprived areas contributes to the mortality gap.