(1616) Community-Level Social Determinants of Health and Sepsis Incidence and Mortality: A Scoping Review

Introduction: Most research on social determinants of health (SDOH) and sepsis focuses on patient-level factors such as race or education. We conducted a scoping review to describe the existing research exploring the association between community-level SDOH (e.g. air quality, food access) and sepsis incidence and/or mortality.

Methods: Review protocol was registered on Open Science Framework, and search was run on 09/2023. Studies published after 1991 when Sepsis 1 definitions were created and examining the association between sepsis incidence, sepsis mortality, and community-level SDOH were identified in PubMed, Embase, Web of Science, Web of Science-Core Collection, Global Health, Cochrane Library, Scopus, and LILACS regional WHO. Screening, full-text review, and data extraction were performed in duplicate. Heterogeneous exposures and outcome variables required a mix of qualitative and semi-quantitative synthesis.

Results: Of 10,442 screened, 93 studies met criteria (0.9%), representing studies from high, middle, and low-income countries, and 3 global studies. Most were retrospective cohort or ecological studies pre-dating the COVID-19 pandemic, and relied on ICD codes to identify patients with sepsis. Sample sizes ranged from 27 to over 60 million. Study populations included individuals across the lifespan. Studies were diverse in terms of geography, demographic, and clinical characteristics. Studies fell into 8 community SDOH domains: economic, educational, environmental, demographic, health access, built environment, housing, and aggregate indices of community-level SDOH; the most common variables were geospatial, such as urban vs. rural, median income by zip code, and distance to medical facility. Many studies found an association between community-level SDOH and sepsis incidence and/or mortality. There was significant methodological heterogeneity between studies, serving as a major limitation of our analysis.

Conclusions: There is evidence to support the association between sepsis incidence and mortality with community-level SDOH exposures. Future research requires a standardized framework to assess community-level SDOH, and prospective cohort studies that leverage such methods to assess their impact on sepsis incidence and mortality, which can inform future clinical and public health interventions.