Race, Income and Insurance Status Affect Neonatal Sepsis Mortality and Healthcare Resource Utilization

Fredrick J. Bohanon, Omar Nunez Lopez, Deepak Adhikari, Hemalkumar Mehta, Yesenia Rojas-Khalil, Kanika Bowen-Jallow, Ravi Radhakrishnan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Socioeconomic disparities negatively impact neonatal health. The influence of sociodemographic disparities on neonatal sepsis is understudied. We examined the association of insurance payer status, income, race and gender on neonatal sepsis mortality and healthcare resource utilization. METHODS: We used the Kid's Inpatient Database, a nationwide population-based survey from 2006, 2009 and 2012. Neonates diagnosed with sepsis were included in the study. Multivariable logistic regression (mortality) and multivariable linear regression (length of stay and total hospital costs) were constructed to determine the association of patient and hospital characteristics. RESULTS: Our study cohort included a weighted sample of 160,677 septic neonates. Several sociodemographic disparities significantly increased mortality. Self-pay patients had increased mortality (odds ratio 3.26 [95% confidence interval: 2.60-4.08]), decreased length of stay (-2.49 ± 0.31 days, P < 0.0001) and total cost (-$5015.50 ± 783.15, P < 0.0001) compared with privately insured neonates. Additionally, low household income increased odds of death compared with the most affluent households (odds ratio 1.19 [95% confidence interval: 1.05-1.35]). Moreover, Black neonates had significantly decreased length of stay (-0.86 ± 0.25, P = 0.0005) compared with White neonates. CONCLUSIONS: This study identified specific socioeconomic disparities that increased odds of death and increased healthcare resource utilization. Moreover, this study provides specific societal targets to address to reduce neonatal sepsis mortality in the United States.

Original languageEnglish (US)
Pages (from-to)e178-e184
JournalThe Pediatric infectious disease journal
Volume37
Issue number7
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

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Insurance Coverage
Infant Mortality
Newborn Infant
Delivery of Health Care
Length of Stay
Mortality
Odds Ratio
Confidence Intervals
Hospital Costs
Inpatients
Linear Models
Sepsis
Cohort Studies
Logistic Models
Neonatal Sepsis
Databases
Costs and Cost Analysis
Population

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Race, Income and Insurance Status Affect Neonatal Sepsis Mortality and Healthcare Resource Utilization. / Bohanon, Fredrick J.; Nunez Lopez, Omar; Adhikari, Deepak; Mehta, Hemalkumar; Rojas-Khalil, Yesenia; Bowen-Jallow, Kanika; Radhakrishnan, Ravi.

In: The Pediatric infectious disease journal, Vol. 37, No. 7, 01.07.2018, p. e178-e184.

Research output: Contribution to journalArticle

Bohanon, Fredrick J. ; Nunez Lopez, Omar ; Adhikari, Deepak ; Mehta, Hemalkumar ; Rojas-Khalil, Yesenia ; Bowen-Jallow, Kanika ; Radhakrishnan, Ravi. / Race, Income and Insurance Status Affect Neonatal Sepsis Mortality and Healthcare Resource Utilization. In: The Pediatric infectious disease journal. 2018 ; Vol. 37, No. 7. pp. e178-e184.
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N2 - BACKGROUND: Socioeconomic disparities negatively impact neonatal health. The influence of sociodemographic disparities on neonatal sepsis is understudied. We examined the association of insurance payer status, income, race and gender on neonatal sepsis mortality and healthcare resource utilization. METHODS: We used the Kid's Inpatient Database, a nationwide population-based survey from 2006, 2009 and 2012. Neonates diagnosed with sepsis were included in the study. Multivariable logistic regression (mortality) and multivariable linear regression (length of stay and total hospital costs) were constructed to determine the association of patient and hospital characteristics. RESULTS: Our study cohort included a weighted sample of 160,677 septic neonates. Several sociodemographic disparities significantly increased mortality. Self-pay patients had increased mortality (odds ratio 3.26 [95% confidence interval: 2.60-4.08]), decreased length of stay (-2.49 ± 0.31 days, P < 0.0001) and total cost (-$5015.50 ± 783.15, P < 0.0001) compared with privately insured neonates. Additionally, low household income increased odds of death compared with the most affluent households (odds ratio 1.19 [95% confidence interval: 1.05-1.35]). Moreover, Black neonates had significantly decreased length of stay (-0.86 ± 0.25, P = 0.0005) compared with White neonates. CONCLUSIONS: This study identified specific socioeconomic disparities that increased odds of death and increased healthcare resource utilization. Moreover, this study provides specific societal targets to address to reduce neonatal sepsis mortality in the United States.

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