Association Between Community-Level Social Determinants of Health and Sepsis Incidence and Mortality: A Scoping Review.

OBJECTIVES: To summarize the research methods, patient populations, and measures used to examine the associations between community-level social determinants of health (SDoH) and sepsis risk, and to describe the findings of the current evidence. DATA SOURCES: PubMed, Embase, Web of Science, Global Health, Cochrane Library, Scopus, Web of Science-Core Collection, and Latin American and Caribbean Literature on Health Sciences Database from January 1, 1991, to October 31, 2024. STUDY SELECTION: Studies were included if they evaluated the quantitative association between at least one community-level SDoH, measured at a spatial level smaller than a country and larger than a household, and sepsis incidence and/or mortality. DATA EXTRACTION: Titles, abstracts, and full-text articles were independently screened in duplicate. Data extraction was performed in duplicate using a standardized form capturing study design, sepsis definition, patient population, community-level SDoH domains, and outcomes. DATA SYNTHESIS: Of the 10,504 studies retrieved, 63 studies were included in the final analysis. The majority of studies (n = 39, 62%) were published between 2020 and 2024. Children (n = 10, 16%) and people in low- or middle-income countries (n = 9, 14%) were the least represented study populations. The most common domains of evaluated SDoH were demographic (n = 31, 49%), health access (n = 17, 27%), and economic (n = 16, 25%), with the most frequent variables being rurality (n = 24, 40%) and median household income by ZIP code (n = 10, 16%). There were 10 (16%) prospective cohort studies, 43 (68%) retrospective cohort, 6 (10%) case-control, and 4 (6%) ecological. Most studies (n = 54, 86%) reported a significant association between at least one community-level SDoH and sepsis incidence and/or mortality. CONCLUSIONS: There is a growing but heterogeneous body of evidence on the associations between community-level SDoH and sepsis risk. Future research requires better representation from populations with the highest sepsis burden, more consistent definitions, and more rigorous, innovative methods to elucidate the mechanisms driving associations between multiple community-level SDoH and sepsis.