May 2021 Maternal Hospitalizations and Sepsis This research brief focuses on patients hospitalized for a delivery or other pregnancy- related condition who also had a diagnosis of sepsis. Sepsis is a life-threatening N condition characterized by a system-wide inflammatory response to infection that can worsen to acute organ dysfunction. PA Health Care Cost Containment Council Included are Pennsylvania female residents and non-residents ages 12-55 who were HVE THT hospitalized for a maternal stay and discharged from a Pennsylvania acute care u hospital from October 2015 through September 2020. For the maternal stays with a diagnosis of sepsis, the sepsis could have developed prior to the hospitalization or ay \ during the hospital stay. The results in this report were not adjusted for age or other patient characteristics to avoid masking important sociodemographic differences. -7 There were 698,576 maternal hospitalizations in total during this five-year timeframe; sepsis was present in 4,794 (0.69%) of these stays. This represents approximately 1 out of every 146 maternal hospitalizations, or 6.9 per 1,000. -~ The average length of the maternal hospital stay was longer for cases with sepsis (5.1 days) compared to those without sepsis (2.7 days), a statistically significant difference. -7 The in-hospital mortality rate was higher for maternal stays with sepsis (0.30%) compared to those without sepsis (0.01%). This difference was also statistically significant. By Age Category Maternal Stays without Sepsis Maternal Stays with Sepsis Age 12-17 2.6% Age 40-55 2.9% Age 12-17 Age 40-55 1.2% 3.1% ~~ Age 35-39 Age 35-39 sab icy Age 18-24 21.5% Age 18-24 30.9% Age 30-34 22.7% PY UL) 30.6% Age 25-29 29.3% Age 25-29 28.6% “7 In comparing maternal patients without sepsis to those with sepsis, sepsis was more likely among patients ages 12-17 and 18-24 and less likely among patients ages 30-34 and 35-39. “7 While patients 12-17 years comprised 1.2% of maternal stays without sepsis, they comprised 2.6% of maternal stays with sepsis. Patients 18-24 years comprised 21.5% of maternal stays without sepsis, but they comprised 30.9% of maternal stays with sepsis. “7 While patients 30-34 years comprised 30.6% of maternal stays without sepsis, they comprised 22.7% of maternal stays with sepsis. Patients 35-39 years comprised 14.5% of maternal stays without sepsis, but they comprised 12.1% of maternal stays with sepsis. fer Pennsylvania Health Care Cost Containment Council 1 By Race/Ethnicity Maternal Stays without Sepsis Maternal Stays with Sepsis Asian, non- Hispanic 3.0% Asian, non- Hispanic Other 3.0% 6.5% Black, non- IS ele aK) Black, non- LIF 1al a ae 25.9% 8.5% White, non- Hispanic Pe lille £7) 13.3% White, non- tertile 65.9% ay In comparing maternal patients without sepsis to those with sepsis, sepsis was more likely in Black, non-Hispanic and Hispanic patients and /ess likely among White, non-Hispanic patients. 7 While Black, non-Hispanic patients comprised 16.2% of maternal stays without sepsis, they comprised , 25.9% of maternal stays with sepsis. Hispanic patients comprised 8.5% of maternal stays without sepsis, but they comprised 13.3% of maternal stays with sepsis. 4 White, non-Hispanic patients comprised 65.9% of maternal stays without sepsis, but they comprised 50.7% of maternal stays with sepsis. By Poverty Rate" Maternal Stays without Sepsis Maternal Stays with Sepsis 25% pove and higher 25% poverty and higher RSS ET 23.6% rele Ta a yy) Less than 10% Ye T aa] eM) 10% to less than 10% to less than 25% poverty 43.3% 25% poverty Ty In comparing maternal patients without sepsis to those with sepsis, sepsis was more likely in patients from high poverty areas. "Patients living in the highest poverty areas (where 25 percent or more of the population lives in poverty) comprised 13.7% of maternal stays without sepsis, but they comprised 23.6% of maternal stays with sepsis. Patients living in areas where 10 percent to less than 25 percent of the population lives in poverty comprised 43.3% of maternal stays without sepsis but 46.6% of maternal stays with sepsis. 4 Patients living in the lowest poverty areas (where less than 10 percent of the population lives in poverty) comprised 43.0% of maternal stays without sepsis but 29.8% of maternal stays with sepsis. “Poverty rates reported in this brief were based on 2019 US Census Bureau estimates at the patient zip code level. rer Pennsylvania Health Care Cost Containment Council 2 Maternal Hospital Stays with Sepsis by County, Oct 2015 — Sep 2020 Rates are based on Pennsylvania residents only (682,271 maternal stays or 97.7% of all maternal hospitalizations). There were 4,620 sepsis cases among maternal stays for Pennsylvania residents for a rate of 6.8 per 1,000. Maternal Stays Rate per 1,000 deli | with Sepsis Maternal Stays ° All PA Residents 4,620 6.8 Juniata NR NR Adams 22 5.0 Lackawanna 69 6.3 Allegheny 233 3.5 Lancaster 171 5.7 Armstrong 10 3.6 Lawrence 22 4.7 Beaver 21 2.6 Lebanon 46 5.9 Bedford 16 7.6 Lehigh 197 9.4 Berks 225 9.3 Luzerne 126 7.4 Blair 17 2.7 Lycoming 38 6.1 Bradford 16 5.6 McKean NR NR Bucks 152 6.2 Mercer 20 3.8 Butler 32 3.4 Mifflin 12 5.7 Cambria 39 5.8 Monroe 58 8.0 Cameron NR NR Montgomery 258 5.9 Carbon 17 5.9 Montour 12 11.2 Centre 27 4.9 Northampton 141 9.1 Chester 108 4.4 Northumberland 47 10.2 Clarion NR NR Perry 20 8.2 Clearfield 22 6.2 Philadelphia 1,323 11.5 Clinton 16 9.6 Pike NR NR Columbia 36 12.3 Potter NR NR Crawford 34 7.9 Schuylkill 34 5.1 Cumberland 55 4.3 Snyder 11 6.2 Dauphin 69 4.0 Somerset 10 3.1 Delaware 268 7.9 Sullivan NR NR Elk NR NR Susquehanna 11 7.3 Erie 83 5.4 Tioga NR NR Fayette 23 3.8 Union 16 9.3 Forest NR NR Venango 10 4.2 Franklin 38 5.4 Warren 15 9.0 Fulton NR NR Washington 24 2.3 Greene NR NR Wayne NR NR Huntingdon 19 9.9 Westmoreland 55 3.5 Indiana 28 7.6 Wyoming NR NR Jefferson 27 11.8 York 159 6.7 NR: Not reported due to low volume. fer Pennsylvania Health Care Cost Containment Council 3