Increased Social Deprivation Index is Associated With Increased Emergency Deparment Visits for Sepsis

Disparities in sepsis care contribute to adverse in-hospital outcomes for disadvantaged groups. While Social Determinants of Health (SDoH) influence many aspects of care, the relationship between social vulnerability and ED utilization for sepsis remains incompletely characterized. Such data are needed to inform development of strategies to improve post-discharge health, quality-of-life, and healthcare resource utilization.

Retrospective review of administrative clinical data paired with ZIP code-level SDoH data from an integrated health system in Detroit, MI. We explored the relationship between Social Deprivation Index (SDI; greater scores indicate more deprivation) and total ED visits for sepsis (primary diagnosis, identified by ICD10 codes) using a zero-truncated Poisson model. Logistic regression was used to determine if SDI was associated with 90-day revisits for sepsis. All models were adjusted for age, gender, hospital, and health insurance status.

From January 2024 to September 2025, there were 1,269 sepsis visits from 1,145 unique patients. Mean age, SDI, and visit count were 65.8 (SD 16.5 years) and 74.8 (32.6), and 1.1 (0.44); the maximum number of visits by a single patient was 6. Each 10-point increase in SDI was associated with a 10% increase in total ED visits for sepsis (95%CI 4 to 30%). Each 1-year increase in age was associated with a 2% decrease in total visits (95% CI -1 to -3%). There were 78 patients with a 90-day return visit; no patients had >1 revisit during the study period. There was no association between SDI and the likelihood of a 90-day return visit (OR 0.78, 95% CI 0.39-1.54); no other covariates were significant in the revisit model.

Nearly 10% of sepsis visits were by patients who had a prior sepsis-related ED visit within the 21-month study period. Area-level social vulnerability plays a small but significant role in this overall occurrence, but not within a 90-day time frame. The negative relationship between age and revisits may be due to mortality of older patients. Future studies of post-discharge outcomes should consider the varied effects of social vulnerability (at the individual and area-level) in the sepsis lifecycle and should include overall healthcare utilization (i.e., not just sepsis-related care) as well as quality-of-life measures.