Katrina Hauschildt, PhD
Advanced Fellow in Health Services Research
VA Ann Arbor Healthcare System, United States
Disclosure information not submitted.
.jpg "Stephanie Taylor, MD, (she/her/hers) photo")
Stephanie Taylor, MD, (she/her/hers)
Wake Forest School of Medicine
Charlotte, North Carolina
Disclosure information not submitted.
Title: The Role of Social Determinants in Post-Sepsis Readmission and Mortality: A systematic review
Introduction: Elucidating the drivers of adverse events after sepsis is a key research focus. Although social determinants of health (SDH) are closely tied to health outcomes, little is known about the association between SDH and post-sepsis outcomes. We systematically evaluated studies of risk factors for post-sepsis rehospitalization or mortality and synthesized the literature to reflect current knowledge and identify gaps in evidence.
Methods: We conducted a systematic search of MEDLINE, Cochrane Library, and EMBASE. Independent double-data extraction followed PRISMA guidelines. Studies were included if 1) the primary cohort comprised patients hospitalized with sepsis, 2) the primary outcome was rehospitalization or mortality after index hospitalization, and 3) the study assessed risk factors for these outcomes. We determined the proportion of eligible studies that included SDH as potential risk factors for post-sepsis outcomes and evaluated the quality of measurement of SDH. We synthesized data to report which social determinants were found to be associated with post-sepsis rehospitalization or mortality.
Results: 3,367 articles were retrieved from databases. Of 103 that met screening criteria, only 33 (32%) included evaluations of SDH as risk factors for post-sepsis rehospitalization or mortality. Of studies that included any SDH, the most commonly evaluated SDH was race/ethnicity in 21 (64%) studies. 12 (36%) studies included insurance type, 10 included marital status or home support, and 7 (21%) included socioeconomic status. Most SDH data were obtained from electronic health records or registry linkage and information about data validation and handling of missing data was frequently not reported. Studies reported mixed findings regarding the association between various SDH and post-sepsis outcomes.
Conclusions: Despite the clinical significance of SDH in health outcomes, only 1 in 3 studies evaluating risk factors for post-sepsis outcomes included any SDH, and only 1 in 4 evaluated SDH other than race/ethnicity. The quality of studies is limited by lack of reporting on measurement error and missing data for SDH. Improved understanding of the social determinants that impact adverse outcomes after sepsis is important to inform interventions that adequately address the whole-person needs of sepsis survivors.