Social Determinants of Sepsis Mortality in the United States: A Retrospective, Epidemiologic Analysis

Abstract

Objective: To determine whether neighborhood-level social determinants of health (SDoH) influence mortality following sepsis in the United States. Study Setting and Design: Retrospective analysis of data from 4.4 million hospitalized patients diagnosed with sepsis, identified using International Classification of Diseases-10 codes, across the United States. Data Sources and Analytic Sample: De-identified, aggregated data were sourced from the TriNetX Diamond Network. SDoH variables included income, housing cost burden, broadband access, park proximity, racial/ethnic diversity, and the Area Deprivation Index (ADI). The primary outcome was mortality, assessed using univariate and multivariate binomial generalized linear models. Predictors with high multicollinearity (Variance Inflation Factor > 5) were excluded to enhance model stability. Principal Findings: Lower median income, higher ADI scores, limited park access, and lack of broadband connectivity were strongly associated with increased sepsis mortality. Unexpectedly, greater racial/ethnic diversity was negatively associated with mortality, possibly reflecting regional disparities in healthcare access and socioeconomic conditions. Multivariate analyses revealed that the inclusion of SDoH variables attenuated some effects observed in univariate models, highlighting their complex interplay. Random Forest analysis identified park access as the most important predictor of sepsis mortality, emphasizing its role as a potential proxy for broader neighborhood resources. Conclusions: Neighborhood-level SDoH are critical for risk stratification in sepsis prognostic models and should be systematically integrated into predictive frameworks. These findings highlight the need for targeted public health interventions to address social vulnerabilities, enhance access to green spaces, and reduce disparities in sepsis outcomes across diverse populations.