Lack of health insurance and low socioeconomic status increase mortality in newborns
By a
Sepsis in the early days of life is the seventh leading cause of death among infants in the
Sepsis is difficult to diagnose in newborns. Signs and symptoms are not specific and standard vital sign measurements, such as temperature and white blood cell count, are not sensitive enough to identify at-risk newborns.3
Previous studies have defined sepsis in the general surgical population, provided screening tools to identify sepsis pre- and postoperatively, and traced the effect of demographic factors, such as race.4 However, few studies have investigated sepsis in newborns, and none have specifically evaluated the relationship between socioeconomics and death in neonates, according to principal study author,
"This nationwide study was done to determine whether sociodemographic factors may help us identify patients who are at high risk for sepsis so that we can intervene and improve outcomes,"
The researchers analyzed information from the Kid's Inpatient Database (KID), a nationwide survey of inpatient discharge data on patients younger than 21 years of age. KID includes clinical information about primary and secondary diagnoses, discharge status, demographics, total charges, and length of stay, as well as measures of disease severity and comorbidity. The UTMB investigators analyzed data from 3 million pediatric discharges over the course of the last three years for which data were available--2006, 2009, and 2012.
From that data set, the researchers identified 160,677 infants who developed sepsis within 28 days of birth. Records of these patients were reviewed to determine whether socioeconomic factors, such as the presence and type of health insurance status and income, were associated with mortality.
Investigators also included in their analysis the severity of illness and low birth weight, which have proved to increase the likelihood of mortality from sepsis for newborns in other studies.
The researchers identified specific groups of newborns with sepsis who had a higher rate of death. As expected, those who were severely ill and had a low birth weight were at the highest risk of death. The odds ratio was as high as 36.1 for infants who were extremely ill, and it was 4.8 for infants who weighed less than 1500 g. at the time of their birth.
Unique to this study were the associations between mortality and insurance status and income. Infants whose families were categorized as self-pay patients had almost a three times greater risk of death from sepsis than families who had private insurance. The odds ratio was 3.26 for infants whose families were self-pay patients. These families have no health insurance coverage, not even
Infants from families whose income was in the lower two quartiles had a 20 percent higher risk of death when compared to those who were considered to be affluent. Household income was
"Sepsis in general has been a focal point of surgical quality improvement efforts for several years.
Keywords for this news article include: Sepsis, Surgery, Septicemia, Epidemiology,
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