(1584) Association of Social Vulnerability With County-Level Sepsis-Related Mortality in the United States

Introduction: Community-level social deprivation is a contributor to increased sepsis-related mortality. However, data on the national-level association of social deprivation with sepsis outcomes across discrete geographical areas are lacking. We aimed to examine the association of county-level Social Vulnerability Index (SVI) and sepsis-related mortality in the United States (US).

Methods: We used the CDC WONDER Multiple Cause of Death dataset to identify decedents with a diagnosis of sepsis during 2010-2019, using previously reported taxonomy. Sepsis-related age-adjusted mortality rates (AAMR) and SVI were merged at the county level. SVI is a composite measure of socioeconomic status, household characteristics, racial/ethnic minority status, and housing type and transportation, and is reported on a 0-1 scale (higher values represent greater social vulnerability). Linear regression models were fit to estimate the association of county-level SVI (modelled as quartiles) with sepsis-related AAMR overall and within race/ethnicity strata.

Results: There were 1,852,610 sepsis-related deaths in the US during 2010-2019. The median (IQR) county-level sepsis-related AAMR was 52.1 (40.5-65.8) overall, ranging from 31.4 (27.6-38.1) among Asians to 100.9 (77.6-120.4) among Native Americans. The median (IQR) county-level SVI was 0.52 (0.27-0.76) overall, ranging from 0.50 (0.29-0.68) among Asians to 0.75 (0.48-0.89) among Native Americans. Residence in upper quartile SVI counties among sepsis decedents was 29.4% overall, ranging from 19.0% among Asians to 50.9% among Native Americans. Absolute sepsis-related AAMRs increased by 10.4 (95% CI 9.9-10.9) per 1 quartile (0.25) rise in SVI overall, ranging from 4.6 (3.3-5.8) among Asians to 10.3 (9.0-11.6) among Blacks. The relative rise in sepsis-related AAMR per 0.25 change in SVI was 20.0% overall, ranging from 7.7% among Native Americans to 23.9% among Hispanics.

Conclusions: Higher county-level SVI was associated with substantial increase in sepsis-related mortality in the US overall and within race/ethnicity groups. However, the race/ethnicity-specific magnitude of this association varied considerably. These findings can inform more targeted efforts to reduce social-deprivation-related disparities in sepsis outcomes within vulnerable groups and communities.