Health Insurance, Socioeconomic Status May Impact Infant Mortality Rate

Lack of health insurance associated with a significantly higher sepsis mortality rate.

A recent analysis found that a significantly high number of newborns die from sepsis if their parents have little income or lack health insurance.

These findings help determine which patients may benefit from early intervention for protection against sepsis, according to a study presented at the 2016 Clinical Congress of the American College of Surgeons.

Sepsis is a serious bloodstream infection, and is a leading cause of death for infants. If not treated quickly, sepsis can result in death or nervous system damage. Despite the need for speedy treatment, diagnosis is difficult in newborns, since the signs and symptoms are not specific, and diagnosis through vital signs is not possible in these patients, according to the study.

Additionally, relatively few studies have examined sepsis in this population, and none have explored the relationship between socioeconomic status and death.

“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,” principal study author, Ravi S. Radhakrishnan, MD, FACS.

The researchers in the current study gathered information from the Kid’s Inpatient Database, which collects data on inpatient discharge for patients younger than 21-years-old. Information such as diagnoses, discharge status, demographics, charges, length of stay, disease severity, comorbidity are all included in the database.

There were 3 million pediatric discharges during 2006, 2009, and 2012 included in the study. Of these patients, 160,677 patients developed sepsis within 28 days from birth, the researchers found.

Researchers explored the relationship between sepsis and socioeconomic status, which includes health insurance status and income. Also examined was the severity of the illness and low birth weight, which have been linked to mortality in other studies.

The analysis confirmed previous findings that infants who were extremely ill and had a low birth weight (less than 1500 grams) were the most at risk of death, with an odds ratio of 36.1 and 4.8, respectively. The researchers also discovered that patients whose parents did not have insurance were 3 times as likely to die from sepsis compared with parents who had private insurance, according to the study. These patients were not even covered through Medicaid.

Patients whose family income was $46,999 or less were 20% more likely to die from sepsis, compared with those who came from families with income higher than $47,000. These findings could potentially provide physicians with risk factors that could to be monitored for newborns to prevent sepsis mortality.

“Sepsis in general has been a focal point of surgical quality improvement efforts for several years. The American College of Surgeons National Surgical Quality Improvement Program, for example, is always trying to help surgery programs prevent sepsis and improve outcomes. Our study findings indicate that we need to focus on specific groups of patients to reduce mortality for newborns,” Dr Radhakrishnan concluded. “The lack of health insurance and low socioeconomic status should raise red flags and tell us that we have to be vigilant about the increased risk of sepsis. In addition, early prenatal interventions targeting at-risk populations, could contribute to better neonatal outcomes.”