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Original Research |

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; James T. McElligott, MD, MSCR; Kit N. Simpson, DrPh; Dee W. Ford, MD, MSCR
Author and Funding Information

Funding information: Supported by Telemedicine & Advanced Technology Research Center, Department of Defense grant number W81XWH-10-2-0057 (DWF, KNS) and the South Carolina Clinical & Translational Research (SCTR) institute at the Medical University of South Carolina, NIH/NCATS Grant numbers KL2 TR000060 and UL1 TR000062 (AJG).

The authors disclose no conflicts of interest related to this study.

1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC

2Department of Pediatrics, Medical University of South Carolina, Charleston, SC

3Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, SC

Corresponding author: Andrew J. Goodwin, MD, MSCR Medical University of South Carolina 96 Jonathan Lucas Dr., Suite 816 CSB, MSC 630 Charleston, SC 29425


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.07.004
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Abstract

Background  Medically underserved areas are comprised 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 non-federal hospitals in South Carolina. We determined whether each resident lived in a medically underserved area or non-medically 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<0.01) and were more likely to die (15.5 vs 11.9 deaths/10,000 people, p<0.01) 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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