System Failure: The Geographic Distribution of Sepsis-Associated Death in the USA and Factors Contributing to the Mortality Burden of Black Communities

Abstract

Sepsis is deadly and costly to health care systems, but these costs are disproportionately born by Black patients. Little empirical work has established the geographic patterning of sepsis or its area-level correlates. This study illustrates the geography of sepsis-associated death and racial composition of US counties with area socioeconomic indicators, health care access, and population health. Cartographic and spatially explicit analyses utilize mortality data from the National Cancer Institute and county data from the American Community Survey, Area Health Resource File, and County Health Rankings. Death rates are highest in the South, Southeast, and Appalachia. Counties disproportionately populated by Black people have higher death rates and associated risk indicators including poor air quality and vaccination coverage, socioeconomic distress, and impaired access to high-quality health care. Spatial Durbin error models suggest that conditions in nearby counties may also influence death rates within focal counties. Racial disparities in sepsis-associated death can be narrowed with improved health care equity-including immunization coverage-and by reducing socioeconomic distress in Black communities. Policy options for achieving these ends are discussed.

Fig. 1

County sepsis-associated death rates, 2015–2019

Fig. 2

County sepsis death rate clusters, 2015–2019

Fig. 3

Correlates of septic mortality rates and county racial composition

Fig. 4

Spatial Durbin error model of sepsis death rates and county characteristics. Notes: Model parameters are standardized and adjusted for county age composition, autocorrelated error term, and all other measures shown in Fig. 3. Error bars correspond to 95% confidence intervals, which indicate a p-value > .05 when overlapping with the vertical line at zero on the x-axis