Where You Live Matters: The Impact of Place of Residence on Severe Sepsis Incidence and Mortality

Chest. 2016 Oct;150(4):829-836. doi: 10.1016/j.chest.2016.07.004. Epub 2016 Jul 19.


Background: Medically underserved areas are composed of vulnerable populations with reduced access to ambulatory care services. Our goal was to determine the association between residence in a medically underserved area and severe sepsis incidence and mortality.

Methods: Using administrative data, we identified adults admitted with severe sepsis to nonfederal hospitals in South Carolina. We determined whether each resident lived in a medically underserved area or nonmedically underserved area from US Census and Department of Health and Human Services data. Age-adjusted severe sepsis incidence and mortality rates were calculated and compared between both residential classifications. Multivariate logistic regression measured the association between residence in a medically underserved area and mortality while adjusting for confounders.

Results: In 2010, 24,395 adults were admitted with severe sepsis and 1,446,987 (43%) adults lived in a medically underserved area. Residents of medically underserved areas were admitted more frequently with severe sepsis (8.6 vs 6.8 cases/1,000 people, P < .01) and were more likely to die (15.5 vs 11.9 deaths/10,000 people, P < .01), with increased odds of severe sepsis-related death (OR, 1.12) after adjustment for age, race, and severity of illness. ZIP code-based surrogates of socioeconomic status, including median income, proportion below poverty level, and educational attainment, however, had minimal association with sepsis mortality.

Conclusions: Residence in a medically underserved area is associated with higher incidence and mortality rates of severe sepsis and represents a novel method of access-to-care adjustment. Traditional access-to-care surrogates, however, are poorly associated with sepsis mortality.

Keywords: epidemiology; health-care disparities; racial disparities; sepsis.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Black or African American / statistics & numerical data
  • Case-Control Studies
  • Cohort Studies
  • Databases, Factual
  • Female
  • Health Status Disparities*
  • Humans
  • Incidence
  • Insurance, Health / statistics & numerical data
  • Logistic Models
  • Male
  • Medicaid
  • Medically Underserved Area*
  • Medicare
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Retrospective Studies
  • Sepsis / epidemiology*
  • Sepsis / mortality
  • Social Class
  • South Carolina / epidemiology
  • United States / epidemiology
  • White People / statistics & numerical data
  • Young Adult