Social Determinants of Sepsis Mortality in the United States: A Retrospective, Epidemiologic Analysis

Sepsis is a leading cause of mortality in the United States, with over 350,000 deaths annually, yet the contribution of neighborhood-level social determinants of health (SDoH) remains underexplored. We conducted a retrospective analysis of 4.4 million hospitalized patients with sepsis, identified using ICD-10 codes, leveraging de-identified data from the TriNetX Diamond Network. Neighborhood-level variables included median income, housing cost burden, broadband access, park proximity, racial/ethnic diversity, and the Area Deprivation Index (ADI). Mortality was the primary outcome, assessed using generalized linear models and Random Forest analysis. Lower neighborhood income, higher ADI scores, limited park access, and lack of broadband connectivity were consistently associated with increased sepsis mortality. Unexpectedly, greater racial/ethnic diversity correlated with lower mortality, potentially reflecting regional differences in healthcare access and socioeconomic context. In multivariate models, several associations observed in univariate analyses were attenuated, highlighting the complex interplay of SDoH. Random Forest modeling identified park access as the most important predictor, suggesting its utility as a proxy for broader neighborhood resources. Neighborhood-level SDoH significantly influence sepsis outcomes and should be integrated into prognostic models to enhance risk stratification. Targeted interventions addressing social vulnerabilities, expanding access to green spaces, and reducing disparities in healthcare resources may help mitigate the burden of sepsis mortality across diverse populations.