Table 1.
Characteristics of all included studies in the review
| Title | Authors | Year | Country | Data source | Population | Sepsis Identification | Factors associated with inequality | Outcome (s) | Sepsis cohort size |
|---|---|---|---|---|---|---|---|---|---|
| Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany - an ecological study | Rose N; Matthaus-Kramer C; Schwarzkopf D; Scherag A; Born S; Reinhart K, Fleischmann-Struzek C | 2021 | Germany | Inpatient database (DRG) covering all acute-care hospitals in Germany (except prison hospitals and psychiatric facilities) | Inpatient admissions in 2016, do not specify age restrictions | Explicit ICD-10 codes and Angus ICD-10 code criteria | Socioeconomic | Crude and age-standardised incidence of sepsis per district in 2016 | 146,985 |
| Association of neighbourhood socioeconomic status with risk of infection and sepsis | Donnelly JP; Lakkr S; Judd SE; Levitan EB; Griffin R; Howard G; Safford MM; Wang HE | 2018 | USA | Reasons for Geographic and Racial Differences in Stroke (REGARDS) study | Hospital admissions between 2003–2012, adults aged over 45 | Chart review using Sepsis-3 criteria | Socioeconomic | Hospital admissions and ED visits for serious infection/sepsis | 964 |
| Black-white racial disparities in sepsis: a prospective analysis of the Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort | Moore J; Donnelly J; Griffin R; Safford M; Howard G; Baddley J; Wang H | 2015 | USA | Reasons for Geographic and Racial Differences in Stroke (REGARDS) study | Hospitalisations for adults over 45 between 2003–2012 | SIRS criteria | Race/ethnicity | Rates of sepsis | 1,526 |
| Socioeconomic status and risk of intensive care unit admission with sepsis | Storm, L; Schegelsberg, A; Andersen, LW; Jessen, MK; Kirkegaard, H | 2018 | Denmark | Tertiary ICU records | Tertiary ICU admissions with, 2008–2010, adults over 18 years old. Matched to up to 10 controls from background population on age, sex & zip code | severe sepsis or septic shock, not stated how identified | Socioeconomic | Admission to ICU with sepsis | 383 |
| Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis | Mayr F; Yende S; Linde-Zwirble W; Peck-Palmer O; Barnato A; Weissfeld L; Angus D | 2010 | USA | Hospital discharge databases of 7 US states | Admissions for all ages with severe sepsis in 2005 | ICD-9 codes | Race/ethnicity | Incidence rates of severe sepsis hospitalisations. | 381,787 |
| Direct and indirect effects of socioeconomic status on sepsis risk and mortality: a mediation analysis of the HUNT study | Stensrud VH; Gustad LT; Damas JK; Solligard E; Krokstad S; Nilsen TIL | 2023 | Norway | Population-based HUNT studies | Adults aged between 20 and 70 admitted to hospital, 1995–1997 and 2006–2008 | ICD-9 & ICD-10 codes, both explicit and implicit list | Socioeconomic | Sepsis and sepsis-attributable mortality | 4,200 |
| Where you live matters: the place of residence on severe sepsis incidence and mortality | Goodwin AJ; Nadig NR; McElligot JT; Simpson KN; Ford DW | 2016 | USA | Hospital discharge database in South Carolina | Adults (> 20 years of age) hospitalised with severe sepsis or septic shock | ICD-9 codes including Martin criteria | Care/medical | Age-adjusted severe sepsis incidence and in-hospital mortality rates | 24,395 |
| Socio-demographic characteristics associated with hospitalisation for sepsis among adults in Canada: a Census-linked cohort study | Hennessy DA; Soo A; Niven DJ; Jolley RJ; Posadas-Calleja J; Stelfox HT; Doig CJ | 2020 | Canada | National hospital discharge database linked to Canadian census | Adults over 18 years admitted with sepsis and severe sepsis, 2006–2009 | ICD-10 codes | Socioeconomic | Hospital admission with a diagnosis of sepsis, secondary in-hospital death, admission to special care unit & LOS, hospital LOS, discharge disposition. | 10,400 |
| Racial differences in sepsis mortality at US academic medical center-affiliated hospitals | Chaudhary N; Donnelly J; Wang H | 2018 | USA | Hospital discharge data from Vizient, covers 120 medical centers and 300 hospitas in US. | Adults > 18 years old hospitalised with sepsis 2012–2014, | Angus ICD-9 codes | Race/ethnicity | Sepsis hospitalisation and hospital mortality. | 1,114,386 |
| Association of household income level and in-hospital mortality in patients with sepsis: a nationwide retrospective cohort analysis | Rush B; Wiskar K; Celi LA; Walley KR; Russell JA; McDermid RC; Boyd, JH | 2018 | USA | Nationwide Inpatient Sample (NIS), covers 20% of national hospital admissions | Identified patients over 18 years with sepsis admission in 2011 | Angus ICD-10 code criteria | Socioeconomic | In-hospital mortality | 671,858 |
| Impact of socioeconmic status on mortality and unplanned readmission in septic intensive care unit patients | Schnegelsberg, A; Mackenhauer, J; Nibro, HL; Dreyer, P; Koch, K; Kirkegaard, H | 2016 | Denmark | Single ICU records | Tertiary ICU admissions with, 2008–2010, adults over 18 years old | severe sepsis or septic shock, not stated how identified | Socioeconomic | 30-day mortality after ICU admission; 180-day mortality after hospital discharge, 180-day unplanned readmission after discharge | 387 |
| Lower socioeconomic factors are associated with higher mortality in patients with septic shock | Hidalgo DC; Tapaskar N; Rao S; Masic D; Su A; Portillo J; Rech M | 2021 | USA | Two hospitals dicharge records | Hospital admissions between 2017–2019, adults aged over 18 | Sepsis-3 criteria for septic shock | Socioeconomic | 30-day mortality, ICU length of stay, hospital length of stay | 362 |
| Race does not impact sepsis outcomes when considering socioeconomic factors in multilevel modeling | Vazquez Guillamet MC; Dodda S; Liu L; Kollef MH; Micek ST | 2022 | USA | Single centre records | Admissions with sepsis or septic shock, all adults (age not specified) 2010–2017 | ICD-9 and ICD-10 codes | Socioeconomic; race/ethnicity | In-hospital mortality, hospital LOS, use of vasopressors, use of mechanical ventilation | 11,432 |
| Race, income and insurance status affect neonatal sepsis mortality and healthcare resource utilisation | Bohanon FJ;. Lopez ON; Adhikari D; Mehta HB; Rojas-Khalil Y; Bowen-Jallow, KA; Radhakrishnan, RS | 2018 | USA | Healthcare Cost and Utilisation Project’s (HCUP) Kids Inpatient Database (KID) | Sepsis admissions in neonates (< 28 days old) in 2006, 2009 & 2012. | ICD-9 codes | Socioeconomic; race/ethnicity | In-hospital mortality, LOS and total costs | 116,882 |
| Association between race and case fatality rate in hospitlisations for sepsis | Sandoval E; Chang DW | 2016 | USA | Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) and California OSHPD Patient Discharge Pivot Database | Adults over 18 years admitted in 2011 | ICD-9 codes Martin criteria | Race/ethnicity | Case-fatality rate | 131,831 |
| Association of gender, age and race on renal outcomes and mortality in patients with severe sepsis and septic shock | Cerceo E; Rachoin JS; Gaughan J; Weisberg L | 2021 | USA | National Inpatient Sample (NIS) | Patients discharged between 2005–2014 after admission for severe sepsis or septic shock | ICD-9 codes for severe sepsis or septic shock | Race/ethnicity | In-hospital mortality | 1,064,790 |
| Ethnicity and sepsis characteristics and outcomes. Population based study | Karp G; Perl Y; Fuchs L; Almog Y; Klein M; Vodonos A; Drieher J: Talmor D; Codish S; Novack V | 2013 | Israel | Single ICU records, sepsis id’d with ICD-9 codes, between 2002–2008 | All adults aged over 20 with sepsis admission, 2002–2008 | ICD-9 codes | Race/ethnicity | In-hospital/28 day mortality | 1,542 |
| Impact of older age and nursing home residence on clinical outcomes of US emergency department visits for severe sepsis | Ginde A; Moss M; Shapiro N; Schwartz R | 2013 | USA | National Hospital Ambulatory Medical Care Survey (NHAMCS) | Adults over 18 years with sepsis ED visits, 2005–2009 | Angus ICD-9 codes | Care/medical | In-hospital mortality, hospital LOS, admission to ICU | 350,000 (estimate) |
| Hospital outcomes for children with severe sepsis in the USA by race or ethnicity and insurance status: a population-based, retrospective cohort study | Mitchell H; Reddy A; Montoya-Williams D; Harhay M; Fowler J; Yehya N | 2020 | USA | Healthcare Cost and Utilization Project (HCUP) Kids Inpatient Database (KID), covering 4200 US hospitals | Patients aged 0–20 years with severe sepsis in 2016 | ICD-10 codes | Race/ethnicity | In-hospital mortality, hospital LOS (death as competing risk, censored at 30 days) | 9,816 |
| Racial disparities in sepsis-related in-hospital mortality: using a broad case capture method and multivariate controls for clinical and hospital variables, 2004–2013 | Jones J; Fingar K; Miller M; Coffey R; Barrett M; Flottemesch T; Heslin K; Gray D; Moy E | 2017 | USA | Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) | Sepsis admissions, no age restrictions | Angus ICD-9 codes | Race/ethnicity | In-hospital mortality rates per 1,000 total sepsis hospitalisations | 16,779,820 |
| Treatment in disproportionately minority hospitals is associated with increased risk of mortality in sepsis: a national analysis | Rush B; Danziger J; Walley KR; Kumar A; Celi LA | 2020 | USA | National Inpatient Sample (NIS) | Sepsis admissions between 2008–2014, adults over 18 years | Angus ICD codes (doesn’t specify version) | Race/ethnicity | In-hospital mortality | 4,221,221 |
| Temporal trends in rural vs. urban sepsis-related mortality in the United States, 2010–2019 | Oud L; Garza J | 2022 | USA | CDC and Prevention Wide Ranging Online Data for Epidemiological Research Multiple Cause of Death dataset | Sepsis-related deaths in US from 2010–2019 | not stated | Community | Age-adjusted mortality rates per 100,000 population | |
| The effect of community socioeconomic status on sepsis-attributable mortality | Galiatsatos P; Brigham EP; Pietri J; Littleton K; Hwang S; Grant MC; Hansel NN; Chen ES | 2018 | USA | Neighborhood Health Profiles for Baltimore City, includes demographic & outcome data for 55 community statistical areas. | 2017 | not stated | Socioeconomic | Sepsis-attributable mortality | |
| Disparities in sepsis mortality by region, urbanisation, and race in the USA, a multiple cause of death analysis | Ogundipe F; Kodadhala V; Ogundipe T; Mehari A; Gillum R | 2019 | USA | CDC multiple cause of death data | Sepsis deaths in people aged 15 or over, between 2013 and 2016 | ICD-10 codes | Race/ethnicity; community | Age-adjusted sepsis death rates | 746,725 |
| Rural patients with severe sepsis or septic shock who bypass rural; hospitals have increased mortality: an instrumental variables approach | Mohr N; Harland K; Shane D; Ahmed A; Fuller B; Ward M; Torner J | 2017 | USA | Administrative claims from emergency departments of midwestern state | All adults over 18 between 2005 and 2014 | ICD-9 codes | Community | Hospital mortality, subsequent interhospital transfer, hospital LOS | 13,461 |
| Sepsis survivors admitted to nursing facilities: cognitive impairment, activities of daily living dependence, and survival | Ehlenbach W; Gilmore-Bykovski A; Repplinger M; Westergaard R; Jacobs E; Kind A; Smith M | 2018 | USA | Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse (CCW) | People aged > 65 with severe sepsis episode, 2005–2009 | Angus ICD-9 codes | Care/medical | 1- year mortality, cognitive impairment, ADL | 175,755 |
| Race and sex based disparities in sepsis | Engoren M; Arslanian-Engoren C | 2022 | USA | Michigan hospital administrative dataset | First episode sepsis between 2009–2019, adults over 18 years | Sepsis-3 criteria | Race/ethnicity | 90-day mortality, mechanical ventilation, RRT, time to initial antibiotic, post-sepsis hospital stay | 34,999 |
| Racial disparities in readmissions following initial hospitalisation for sepsis | Lizza B; Betthauser K; Juang P; Hampton N; Lyons P; Kollef M; Micek S | 2021 | USA | Tertiary care referral center | Patients hospitalised for severe sepsis and septic shock (and survived) between 2010–2017 | ICD-9 and ICD-10 codes for severe sepsis and septic shock. | Race/ethnicity | All-cause readmission, sepsis readmission, postdischarge death. | 3,390 |
| The association between neighborhood socioeconomic disadvantage and readmissions for patients hospitalised with sepsis | Galiatsatos P; Follun A; Alghanim F; Sherry M; Sylvester C; Daniel Y; Chanmugam A; Townsend J; Saria S; Kind AJ; Chen E | 2020 | USA | Single hospital records | Sepsis admissions who survived to discharge, adults over 18 years in 2017 | ICD-10 codes then reviewed charts for Sepsis-3 criteria | Socioeconomic | 30-day readmission | 531 |
| Inclusion of social determinants of health improves sepsis readmission prediction models | Amrollahi F; Shashikumar S; Meier A; Ohno-Machado L; Nemati S; Wardi G | 2022 | USA | AllofUs study covering 35 hospitals | Patients over 18 years old admitted to hospital between 2017 and 2021 | Sepsis-3 criteria | Socioeconomic | 30-day unplanned readmission in sepsis patients | 8,935 |
| Risk factors, etiologies, and screening tools for sepsis in pregnant women: a multicenter case-control study | Bauer M; Housey M; Bauer S; Behrmann S; Chau A; Clancy C; Clark E; Einav S; Langen E; Leffert L; Lin S; Madapu M; Maile M; Mcquaid-Hanson E; Priessnitz K; Sela H; Shah A; Sobolewski P; Toledo P; Tsen L; Bateman B | 2019 | USA/Israel | Admissions data from 7 hospitals | Delivery admissions between 1994–2012 (depending on centre), matched 1:4 to non-sepsis controls | ICD-9 codes for sepsis, severe sepsis or septic shock, with manual chart review | Pregnancy | Risk factors | 82 |
| Severe sepsis in women with group B Streptococcus in pregnancy: An exploratory UK national case-control study | Kalin A; Acosta C; Kurinczuk J; Brocklehurst P; Knight M | 2015 | UK | UK Obstetric Surveillance System | All cases of severe maternal sepsis caused by Group B Streptococcus (GBS), 2011–2012, matched with controls who were non-sepsis deliveries | Prospective chart review, severe sepsis with laboratory confirmation of GBS | Pregnancy | Incidence of GBS sepsis, risk factors | 30 |
| The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study | Acosta C; Knight M; Lee H; Kurinczuk J; Gould J; Lyndon A | 2013 | USA | California Vital Statistics records linked with statewide hospital discharge data | Maternal sepsis cases among all in-hospital live births, 2005–2007 | ICD-9 codes | Pregnancy | Incidence of sepsis and severe sepsis, risk factors | 1,598 |
| Maternal obesity, obstetric interventions and post-partum anaemia increase the risk of post-partum sepsis: a population-based cohort study based on Swedish medical health registers | Axelsson D; Blomberg M | 2017 | Sweden | Medical Birth Registry, National Patient Register and Prescribed Drug Register | Maternal sepsis in women who gave birth between 1997–2012 | ICD-10 codes | Pregnancy | Incidence and risk factors for post-partum sepsis | 376 |
| Severe maternal sepsis in the UK, 2011–2012: A National Case-Control Study | Acosta C; Kurinczuk J; Lucas D; Tuffnell D; Sellers S; Knight M | 2014 | UK | UK Obstetric Surveillance System | Maternal severe sepsis or septic shock, 2011–2012, matched to non-sepsis controls who delivered immediately before in same hospital | Prospective chart review | Pregnancy | Incidence and risk factors for severe maternal sepsis | 365 |
| Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study | Knowles S; O’Sullivan N; Meenan A; Hanniffy R; Robson M | 2015 | Ireland | Hospital records from two maternity hospitals | Pregnant and postpartum women with maternal sepsis between 2005–2012 | Prospective chart review identifying primary or secondary BSI | Pregnancy | Incidence, maternal mortality and neonatal mortality | 272 |
| Case fatality and adverse outcomes are reduced in pregnant women with severe sepsis or septic shock compared with age-matched comorbid-matched nonpregnant women | Kidson K; Henderson W; Hutcheon J | 2018 | USA | National Inpatient Sample | Severe sepsis or septic shock in pregnancy admissions, women aged between 15–44 years, between 1998–2012. Compared with severe sepsis in non-pregnant women of the same age | ICD-9 codes | Pregnancy | Case fatality rates in pregnancy associated severe sepsis (PASS) and non-PASS (NPSS), hospital LOS | 5,968 |
| Maternal morbiditiy and mortality from severe sepsis: a national cohort study | Acosta C; Harrison D; Rowan K; Lucas D; Kurinczuk J; Knight M | 2016 | UK (excluding Scotland) | Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme | Severe sepsis in pregnant or recently pregnant women, admitted to critical care, between 2008–2010 | Infection, at least 3 SIRS criteria and at least one organ dysfunction | Pregnancy | Maternal critical care admission rates, risk factors and death rates | 646 |
| Contemporary trends of reported sepsis among maternal decedents in Texas: a population-based study | Oud L | 2015 | USA | Texas Inpatient Public Use Data File (TIPUDF), covers all state-licensed hospitals | Pregnancy associated hospitalizations between 2001–2010 | ICD-9 codes, for septic shock or infection (SIRS) in combination with organ failure | Pregnancy | Annual rate of sepsis among maternal decedents | 131 |
| Mortality associated with severe sepsis among age-similar women with and without pregnancy-associated hospitalization in Texas: a population-based study | Oud L | 2016 | USA | Texas Inpatient Public Use Data File (TIPUDF), covers all state-licensed hospitals | Pregnancy associated hospitalizations between 2001–2010 in women aged 20–34, compared with non pregnancy-associated hospitalizations | ICD-9 codes, for septic shock or infection (SIRS) in combination with organ failure | Pregnancy | Hospital mortality, number and type of failing organs | 449 |
| Progression from severe sepsis in pregnancy to death: a UK population-based case-control analysis | Mohamed-Ahmed O; Nair M; Acosta C; Kurinczuk J; Knight M | 2015 | UK | UK Obstetric Surveillance System and Confidential Enquiry into Maternal Death (CEMD) | Maternal deaths from non-influenza sepsis, compared with women who survived, between 2009–2012 | Prospective chart review | Pregnancy | Risk factors associated with sepsis death | 401 |
| The sepsis in obstetrics score: a model to identify risk of morbidity from sepsis in pregnancy | Albright C; Ali T; Lopes V; Rouse D; Anderson B | 2014 | Discharge records from single centre | Pregnant and postpartum women presenting at ED with suspected SIRS or sepsis, between 2009 to 2011 | SIRS with swab confirmation | Pregnancy | Morbidity - ICU admission within 48 h of presentation to ED, mortality, adverse perinatal outcome | 850 | |
| Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes | Snyder C; Barton J; Habli M; Sibai B | 2013 | Hospital records from two hospitals | Obstetric patients treated in ICU between 1995 to 2010 with severe sepsis or septic shock | ICD-9 codes confirmed with chart review | Pregnancy | Mortality, morbidity | 30 | |
| Perinatal outcomes among patients with sepsis during pregnancy | Blauvelt C; Nguyen K; Cassidy A; Gaw S | 2021 | USA | Hospital records from single center | Patients who delivered at 20 weeks gestation or later, with antepartum clinical concern for sepsis discharged before delivery, 2012–2018 | ICD-9 and ICD-10 codes | Pregnancy | Composite perinatal outcome of 1 or more of the following: fetal growth restriction, oligohydramnios, hypertensive disease of pregnancy, cesarean delivery, infant born small for gestational age, or stillbirth | 59 |
| Correlation of bacterial type and antibiotic sensitivity with antibiotic exposure in early-onset neonatal sepsis | Bromiker R; Ernest N; Meir M; Kaplan M; Hammerman C; Schimmel M; Schlesinger Y | 2013 | Israel | Hospital records from single center | Infants born betweem 1997–2007 with early onset neonatal sepsis | Culture confirmed infection | Pregnancy | Isolates with antibiotic resistance, Gram-negative isolates | 94 |
| Is peri-partum maternal fever alone a reliable predictor of neonatal sepsis? A single-centre, retrospective cohort study | Gupta S; Forbes-Coe A; Rudd D; Kandasamy Y | 2021 | Australia | Hospital records from single center | Term infants admitted to neonatal ICU with sepsis, between 2015 to 2020 | Culture-proven neonatal bacteraemia and sepsis | Pregnancy | Predictors of EONS | 14 |
| Early-onset sepsis: a predictive model based on maternal risk factors | Puopolo K; Escobar G | 2013 | USA | Hospital records from multiple centers | Live births > = 34 weeks gestation with EONS from 1995–2007, matched to controls | Pregnancy | Predictors of EONS | 350 | |
| Maternal obesity and risk of early onset neonatal bacterial sepsis: nationwide cohort and sibling-controlled studies | Villamor E; Norman M; Johansson S; Cnattingius S | 2020 | Sweden | Medical Birth Register | Live births > = 22 weeks, between 1997–2016 with EOS admission to neonatal unit within 72 h of birth | ICD-10 codes | Pregnancy | Incidence and risk factors of EONS | 2,913 |
| Maternal antibiotic exposure and risk of antibiotic resistance in neonatal early-onset sepsus: a case-cohort study | Wright A; Unger S; Coleman B; Lam P; McGeer A | 2012 | Canada | Hospital records from single center | Admissions to neonatal ICU within 24 h after birth, between 2008–2010 | Confirmed serious bacterial infection | Pregnancy | Antibiotic resistance in EONS | 60 |
ED – emergency department, LOS – length of stay, RRT – renal replacement therapy, EONS – early onset neonatal sepsis, ICU – intensive care unit, ADL – activities of daily living