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Original Research: Critical Care |

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

Andrew J. Goodwin, MD, MSCR; Nandita R. Nadig, MD, MSCR; James T. McElligott, MD, MSCR; Kit N. Simpson, DrPh; Dee W. Ford, MD, MSCR
Author and Funding Information

FUNDING/SUPPORT: This study was funded by the Telemedicine & Advanced Technology Research Center, Department of Defense [Grant W81XWH-10-2-0057] to D. W. F. and K. N. S.; and the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina [NIH/NCATS Grants KL2 TR000060 and UL1 TR000062] to A. J. G.

aDivision of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC

bDepartment of Pediatrics, Medical University of South Carolina, Charleston, SC

cDepartment of Health Care Leadership and Management, Medical University of South Carolina, Charleston, SC

CORRESPONDENCE TO: Andrew J. Goodwin, MD, MSCR, Medical University of South Carolina, 96 Jonathan Lucas Dr, Ste 816 CSB, MSC 630, Charleston, SC 29425;


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


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

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