Maharaj, Ritesh 
ORCID: 0000-0003-3667-2426, Rola, Ishan and Papanicolas, Irene ORCID: 0000-0002-8000-3185
(2025)
The relationship between neighbourhood deprivation and mortality in a sepsis cohort in England: a retrospective observational study.
CHEST Critical Care.
p. 100165.
ISSN 2949-7884
(In Press)
Abstract
Background Worse health outcomes have been described for sepsis patients from more deprived neighbourhoods, but it is unclear if this disparity gap has narrowed. Moreover, the mechanisms by which neighborhood disadvantage influences sepsis outcomes are not fully understood. Research Question What is the trajectory of mortality among sepsis patients in England across varying levels of neighborhood deprivation, and to what extent do patterns of ICU admission and treatment explain observed differences? Study Design and Methods Retrospective observational study using multivariable logistic regression. Setting 304 ICUs from 207 Acute hospitals in England. The primary outcome was hospital mortality. The secondary outcomes were direct ICU admission from the Emergency Department, use of mechanical ventilation, renal replacement therapy, vasopressor therapy and decisions to limit life sustaining therapy. Results 519,789 patients above 16 years of age, admitted to the ICU with sepsis between 1 April 2009 and 31 December 2023. Mortality improved across all groups of neighbourhood deprivation from the baseline period in 2009-2011 and was 4.5% lower in 2022-2023 in the most deprived and 4.4% lower in the least deprived quartile, with no significant narrowing of the disparity gap over time (p=0.833). Direct ICU admission from the Emergency Department was similar for patients across groups of neighbourhood deprivation at baseline and increased similarly over time with no significant between-group difference. The gap in mechanical ventilation, renal placement therapy and vasopressor utilisation narrowed over time. Mortality trends were primarily driven by within-hospital improvements in care and only a minor component was attributable to shift of patients from lower- to higher-quality hospitals. Interpretation: Interpretation Although sepsis mortality has improved across England, there is a persistent disparity associated with neighborhood deprivation. Further investigation is required to evaluate other potential contributory factors to help better understand how living in deprived areas contributes to the mortality gap.
| Item Type: | Article |
|---|---|
| Additional Information: | © 2025 The Author(s) |
| Divisions: | ?? UNIT000020 ?? ?? UNIT000072 ?? |
| Subjects: | H Social Sciences R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Date Deposited: | 07 May 2025 16:27 |
| Last Modified: | 07 May 2025 16:27 |
| URI: | http://eprints.lse.ac.uk/id/eprint/128083 |
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