Social determinants of health and sepsis: a case-control study

PurposeWe aimed to identify whether social determinants of health (SDoH) are associated with the development of sepsis and assess the differences between individuals living within systematically disadvantaged neighbourhoods compared with those living outside these neighbourhoods.MethodsWe conducted a single-centre case-control study including 300 randomly selected adult patients (100 patients with sepsis and 200 patients without sepsis) admitted to the emergency department of a large academic tertiary care hospital in Hamilton, ON, Canada. We collected data on demographics and a limited set of SDoH variables, including neighbourhood household income, smoking history, social support, and history of alcohol disorder. We analyzed study data using multivariate logistic regression models.ResultsThe study included 100 patients with sepsis with a median [interquartile range (IQR)] age of 75 [58-84] yr and 200 patients without sepsis with a median [IQR] age of 72 [60-83] yr. Factors significantly associated with sepsis included arrival by ambulance, absence of a family physician, higher Hamilton Early Warning Score, and a recorded history of dyslipidemia. Important SDoH variables, such as individual or household income and race, were not available in the medical chart. In patients with SDoH available in their medical records, no SDoH was significantly associated with sepsis. Nevertheless, compared with their proportion of the Hamilton population, the rate of sepsis cases and sepsis deaths was approximately two times higher among patients living in systematically disadvantaged neighbourhoods.ConclusionsThis study revealed the lack of available SDoH data in electronic health records. Despite no association between the SDoH variables available and sepsis, we found a higher rate of sepsis cases and sepsis deaths among individuals living in systematically disadvantaged neighbourhoods. Including SDoH in electronic health records is crucial to study their effect on the risk of sepsis and to provide equitable care. ObjectifNous avons cherch & eacute; & agrave; d & eacute;terminer si les d & eacute;terminants sociaux de la sant & eacute; (DSS) & eacute;taient associ & eacute;s & agrave; l'apparition de sepsis et & agrave; & eacute;valuer les diff & eacute;rences entre les personnes vivant dans des quartiers syst & eacute;matiquement d & eacute;favoris & eacute;s et celles vivant & agrave; l'ext & eacute;rieur de ces quartiers.M & eacute;thodeNous avons men & eacute; une & eacute;tude cas t & eacute;moins monocentrique portant sur 300 patient<middle dot>es adultes s & eacute;lectionn & eacute;<middle dot>es au hasard (100 personnes atteintes de sepsis et 200 t & eacute;moins sans sepsis) admis<middle dot>es au service des urgences d'un grand h & ocirc;pital universitaire de soins tertiaires & agrave; Hamilton, ON, Canada. Nous avons recueilli des donn & eacute;es d & eacute;mographiques et un ensemble limit & eacute; de variables de DSS, y compris le revenu des m & eacute;nages du quartier, les ant & eacute;c & eacute;dents de tabagisme, le soutien social et les ant & eacute;c & eacute;dents de troubles li & eacute;s & agrave; l'alcool. Nous avons analys & eacute; les donn & eacute;es de l'& eacute;tude & agrave; l'aide de mod & egrave;les de r & eacute;gression logistique multivari & eacute;s.R & eacute;sultatsL'& eacute;tude a inclus 100 patient<middle dot>es atteint<middle dot>es de sepsis avec un & acirc;ge m & eacute;dian [& eacute;cart interquartile (& Eacute;IQ)] de 75 [58-84] ans et 200 patient<middle dot>es sans sepsis avec un & acirc;ge m & eacute;dian [& Eacute;IQ] de 72 [60-83] ans. Les facteurs significativement associ & eacute;s au sepsis comprenaient l'arriv & eacute;e en ambulance, l'absence de m & eacute;decin de famille, un score Hamilton Early Warning Score plus & eacute;lev & eacute; et des ant & eacute;c & eacute;dents enregistr & eacute;s de dyslipid & eacute;mie. D'importantes variables de DSS, telles que le revenu individuel et du m & eacute;nage et la race, n'& eacute;taient pas disponibles dans le dossier m & eacute;dical. Chez les personnes dont les DSS & eacute;taient disponibles dans leur dossier m & eacute;dical, aucun DSS n'& eacute;tait significativement associ & eacute; au sepsis. N & eacute;anmoins, comparativement & agrave; leur proportion dans la population de Hamilton, le taux de cas de sepsis et de d & eacute;c & egrave;s dus au sepsis & eacute;tait environ deux fois plus & eacute;lev & eacute; chez les personnes vivant dans des quartiers syst & eacute;matiquement d & eacute;favoris & eacute;s.ConclusionCette & eacute;tude a r & eacute;v & eacute;l & eacute; le manque de donn & eacute;es disponibles sur les DSS dans les dossiers de sant & eacute; & eacute;lectroniques. Bien qu'il n'y ait pas d'association entre les variables disponibles et le sepsis, nous avons constat & eacute; un taux plus & eacute;lev & eacute; de cas de sepsis et de d & eacute;c & egrave;s dus & agrave; la septic & eacute;mie chez les personnes vivant dans des quartiers syst & eacute;matiquement d & eacute;favoris & eacute;s. L'inclusion des DSS dans les dossiers de sant & eacute; & eacute;lectroniques est cruciale pour & eacute;tudier leur effet sur le risque de sepsis et pour dispenser des soins & eacute;quitables.