Jonathan D Baghdadi1, Mitchell Wong2, W Scott Comulada3, Daniel Z Uslan4. 1. UCLA, Division of Infectious Diseases, 10833 Le Conte Avenue, CHS Room 37-121, Los Angeles, CA 90024, United States. Electronic address: jbaghdadi@mednet.ucla.edu. 2. UCLA, Division of General Internal Medicine, 911 Broxton Ave, Los Angeles, CA 90024, United States. Electronic address: mitchellwong@mednet.ucla.edu. 3. UCLA, Department of Psychiatry and Biobehavioral Sciences, 10920 Wilshire Blvd Suite 350, 90024, United States. Electronic address: wcomulada@mednet.ucla.edu. 4. UCLA, Division of Infectious Diseases, 10833 Le Conte Avenue, CHS Room 37-121, Los Angeles, CA 90024, United States. Electronic address: duslan@mednet.ucla.edu.
Abstract
Nationally-representative data suggest an association between lack of insurance and in-hospital death from sepsis (Kumar et al., 2014). It remains to be determined whether this association is attributable to differences in baseline health, care-seeking behaviors, hospital care, or other factors. PURPOSE: To determine whether organ dysfunction present on admission for community-onset sepsis mediates the association between lack of insurance and mortality in sepsis. MATERIALS AND METHODS: Retrospective cohort study using public discharge data from the California Office of Statewide Health Planning and Development. Inpatients age 18-64 with community-onset sepsis at California hospitals in 2010 were identified by diagnosis codes. RESULTS: Controlling for demographics, comorbidities, infection source, and hospital characteristics, lack of insurance was associated with an adjusted odds ratio (OR) of 1.26 (absolute risk difference 4.75%, p<0.001) for organ dysfunction present on admission for community-onset sepsis. Lack of insurance predicted in-hospital mortality (adjusted OR 1.15, p<0.001). Organ dysfunction present on admission was the only significant mediator, explaining 22.3% (p<0.001) of the effect of lack of insurance. CONCLUSIONS: The association between lack of insurance and organ dysfunction on admission in community-onset sepsis suggests that lack of insurance may impede timely care for patients with community-onset infections.
Nationally-representative data suggest an association between lack of insurance and in-hospital death from sepsis (Kumar et al., 2014). It remains to be determined whether this association is attributable to differences in baseline health, care-seeking behaviors, hospital care, or other factors. PURPOSE: To determine whether organ dysfunction present on admission for community-onset sepsis mediates the association between lack of insurance and mortality in sepsis. MATERIALS AND METHODS: Retrospective cohort study using public discharge data from the California Office of Statewide Health Planning and Development. Inpatients age 18-64 with community-onset sepsis at California hospitals in 2010 were identified by diagnosis codes. RESULTS: Controlling for demographics, comorbidities, infection source, and hospital characteristics, lack of insurance was associated with an adjusted odds ratio (OR) of 1.26 (absolute risk difference 4.75%, p<0.001) for organ dysfunction present on admission for community-onset sepsis. Lack of insurance predicted in-hospital mortality (adjusted OR 1.15, p<0.001). Organ dysfunction present on admission was the only significant mediator, explaining 22.3% (p<0.001) of the effect of lack of insurance. CONCLUSIONS: The association between lack of insurance and organ dysfunction on admission in community-onset sepsis suggests that lack of insurance may impede timely care for patients with community-onset infections.
Authors: Alexander H Flannery; Chad M Venn; Amanda Gusovsky; Stephanie Henderson; Adam S Kiser; Hallie C Prescott; Chanu Rhee; Chris Delcher; Peter E Morris Journal: Crit Care Explor Date: 2022-02-04