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Multicenter Study
. 2019 Jul 9;23(1):250.
doi: 10.1186/s13054-019-2522-6.

Health inequities in the diagnosis and outcome of sepsis in Argentina: a prospective cohort study

Elisa Estenssoro  1 , Cecilia I Loudet  2 , Vanina S K Edul  3 , Javier Osatnik  4 , Fernando G Ríos  5 , Daniela N Vásquez  6 , Mario O Pozo  7 , Bernardo Lattanzio  8 , Fernando Pálizas  7 , Francisco Klein  9 , Damián Piezny  5 , Paolo N Rubatto Birri  10 , Graciela Tuhay  9 , Anatilde Díaz  11 , Analía Santamaría  12 , Graciela Zakalik  13 , Arnaldo Dubin  10 ; investigators of the SATISEPSIS Group
Collaborators, Affiliations
Multicenter Study

Health inequities in the diagnosis and outcome of sepsis in Argentina: a prospective cohort study

Elisa Estenssoro et al. Crit Care. .

Abstract

Background: Socioeconomic variables impact health outcomes but have rarely been evaluated in critical illness. Low- and middle-income countries bear the highest burden of sepsis and also have significant health inequities. In Argentina, public hospitals serve the poorest segment of the population, while private institutions serve patients with health coverage. Our objective was to analyze differences in mortality between public and private hospitals, using Sepsis-3 definitions.

Methods: This is a multicenter, prospective cohort study including patients with sepsis admitted to 49 Argentine ICUs lasting 3 months, beginning on July 1, 2016. Epidemiological, clinical, and socioeconomic status variables and hospital characteristics were compared between patients admitted to both types of institutions.

Results: Of the 809 patients included, 367 (45%) and 442 (55%) were admitted to public and private hospitals, respectively. Those in public institutions were younger (56 ± 18 vs. 64 ± 18; p < 0.01), with more comorbidities (Charlson score 2 [0-4] vs. 1 [0-3]; p < 0.01), fewer education years (7 [7-12] vs. 12 [10-16]; p < 0.01), more frequently unemployed/informally employed (30% vs. 7%; p < 0.01), had similar previous self-rated health status (70 [50-90] vs. 70 [50-90] points; p = 0.30), longer pre-admission symptoms (48 [24-96] vs. 24 [12-48] h; p < 0.01), had been previously evaluated more frequently in any healthcare venue (28 vs. 20%; p < 0.01), and had higher APACHE II, SOFA, lactate levels, and mechanical ventilation utilization. ICU admission as septic shock was more frequent in patients admitted to public hospitals (47 vs. 35%; p < 0.01), as were infections caused by multiresistant microorganisms. Sepsis management in the ICU showed no differences. Twenty-eight-day mortality was higher in public hospitals (42% vs. 24%; p < 0.01) as was hospital mortality (47% vs. 30%; p < 0.01). Admission to a public hospital was an independent predictor of mortality together with comorbidities, lactate, SOFA, and mechanical ventilation; in an alternative prediction model, it acted as a correlate of pre-hospital symptom duration and infections caused by multiresistant microorganisms.

Conclusions: Patients in public hospitals belonged to a socially disadvantaged group and were sicker at admission, had septic shock more frequently, and had higher mortality. Unawareness of disease severity and delays in the health system might be associated with late admission. This marked difference in outcome between patients served by public and private institutions constitutes a state of health inequity.

Keywords: Health inequity; SES; Sepsis awareness; Sepsis-3; Septic shock; Socioeconomic status.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the SATISEPSIS study and distribution of ICUs according to their location in public and private hospitals
Fig. 2
Fig. 2
Differences in time to survival in patients admitted to public and private hospitals
See this image and copyright information in PMC

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