S2075 Socioeconomic and Insurance-Based Disparities in Mortality Among Patients With Spontaneous Bacterial Peritonitis and Sepsis: A National Inpatient Sample Analysis

Introduction: Spontaneous bacterial peritonitis (SBP) is a serious complication of liver disease, and when accompanied by sepsis, it significantly increases morbidity and mortality. Understanding the effects of socioeconomic status in outcomes of patients with SBP and sepsis is essential for targeted interventions and health equity. This study analyzes the demographic and socioeconomic disparities in outcomes among patients hospitalized with SBP and sepsis using a national database. Methods: Data from the National Inpatient Sample (NIS) database from 2019 to 2021 were analyzed to identify hospitalization involving SBP. Patients with concurrent sepsis were extracted for subgroup analysis. Income was categorized into 4 quartiles (Q): Q1 (≤$43,000), Q2 ($44,000-$55,900), Q3 ($56,000-$73,000), and Q4 (≥$74,000). Insurance coverage was categorized into Medicare, Medicaid, private insurance, and self-pay. Multivariate logistic was used to adjust for confounders. The primary outcome was inpatient mortality. STATA software was utilized for statistical analysis. Results: Among 116,160 patients with SBP, 22,559 (19.4%) had concurrent sepsis. Among the subgroup, income distribution was as follows: Q1 with 30.8%, Q2 with 25.9%, Q3 with 24.5%, and Q4 with 18.8%. In respect to payer status, the majority of patients were insured by Medicare (41.3%), followed by Medicaid (25.9%), private insurance (24.8%), and self-pay (5.1%). Inpatient mortality varied significantly based on payer type with a P-value of 0.0109. The highest mortality was observed in the Medicaid (53.2%) and self-pay patients (53.1%), followed by those with private insurance (48.4%) and Medicare (47.2%). Conclusion: This national analysis reveals significant disparities in the prevalence and outcomes of patients with SBP and sepsis based on socioeconomic and insurance status. Patients from lower-income quartiles were more frequently hospitalized with SBP and sepsis, indicating a link between lower socioeconomic status and increased disease burden. Significant differences in in-hospital mortality were observed based on payer status. Patients insured through Medicaid and self-pay had the highest mortality rates. These findings underscore the need to investigate systemic changes to improve access and continuity of care for socioeconomically disadvantaged populations.