Hamilton residents living in north and east-end neighbourhoods with L8L and L8H postal codes and mountain neighbourhoods with an L8V postal code develop almost double the amount of sepsis compared to those living elsewhere in the city, a study published in the Canadian
Journal of Anesthesia has found.

Any type of infection can lead to sepsis, including bacterial, viral or fungal infections, and as many as one in three people with this disease will die. Common causes include pneumonia, kidney, bladder or bloodstream infections; wounds or burns that become infected; or infections at catheter sites. Sepsis can happen at home or in hospital if an inpatient develops an infection. Preventing hospital-acquired sepsis is strategic priority for HHS. 

Several Hamilton communities – including neighbourhoods in these postal codes – have long been identified as facing increased challenges, such as more difficulty accessing health care, higher rates of poverty, and language barriers.

Next steps: Understanding “the why”

The study’s findings tell us what’s happening in these postal codes in regards to sepsis, says Fatima Sheikh, the McMaster University PhD candidate who led the study. But the data doesn’t reveal why. 

“We know `the what.’ Now we need to understand `the why,’ and importantly, how we work with our communities to reduce these inequities,” says Sheikh, who is also an HHS health equity specialist. 

Collecting health equity data is critical to understanding ‘the why.’

Closing the equity gap a longtime challenge

Back in 2010, the Hamilton Spectator’s Code Red coverage revealed significant disparities in health outcomes across the city, including a difference of 21 years in average age of death, in communities just five minutes apart. A follow-up series by the Spectator 10 years later found little had changed, and in some cases the health equity gap had actually widened, in spite of significant efforts to close the gap. 

“That to me was mind blowing,” says Sheikh, who first learned of the Code Red project as an undergraduate student.

At the time of Sheikh’s sepsis study, close to 18 per cent of Hamilton residents lived in the three postal code regions, with the remaining 82 per cent making up the rest of the city’s population. 

“Our research found 33 sepsis cases per 100,000 residents in these three postal code areas, compared to 15 per 100,000 residents in the rest of the city,” says Sheikh. “It’s almost twice as many in the three postal code areas, yet this represents such a small sliver of our city’s population. That, to us, was staggering.”

Collecting Accurate and Robust Equity (CARE) data

As an HHS health equity specialist, Sheikh is part of the hospital’s equity, diversity and inclusion (EDI) team that is leading an initiative to collect health equity (CARE) data from patients, confidentially and voluntarily.

Health equity data will help HHS health-care teams to better understand the diverse needs of patients, identify and address challenges that prevent equitable access to health care, and improve culturally-sensitive care. 

This initiative aims to tackle health-care disparities and develop ways to measure and evaluate how collecting health equity data is helping. Taking steps to close the health-equity gap should also help reduce sepsis rates in systemically disadvantaged neighbourhoods.

“Understanding health equity data is essential for creating a health-care system that truly values and respects the diverse needs and experiences of all individuals,” says Rochelle Reid, senior lead and strategic advisor for EDI at HHS. “By collecting and utilizing CARE data, we can foster a culture of inclusivity, empathy, and equity, ultimately leading to better health outcomes and an equitable approach to patient care.”

 Preventing sepsis is a strategic priority for HHS, as is equity, diversity and inclusion, says Dr. Alison Fox-Robichaud, an HHS critical care physician and the scientific director of Sepsis Canada. She is also the HHS chair in sepsis research.

 “This study and the work by our EDI team are important steps in ensuring we have the knowledge and resources to improve sepsis care and prevention for all city residents.”

The collection of equity data began as a pilot program at the HHS Boris Clinic and HHS Ron Joyce Children’s Health Centre in 2023, where more than 2,400 patients volunteered to provide information about their race, ethnicity and preferred language.

A working group was also formed to connect HHS team members with community members to ensure that the collection of health equity data is respectful, inclusive and equitable, and to develop guidelines and policies for the use of data at HHS. 

“Data collection is certainly important,” says Sheikh. “But we recognize that there are people and stories behind these data, so we can’t just report the numbers. We’re committed to working with communities, and we’re starting to do that at HHS.” 

The hospital holds a seat on the Greater Hamilton Health Network’s Health Equity Table, Kids Health Alliance Data Collection Working Group and continues to work with Ontario Health West Equity Diversity and Inclusion team to support and coordinate health equity efforts regionally.

For next steps, HHS is now working to make health equity data collection standard practice across many of the hospital sites beginning with establishing a process to collect this data using e-Check-in and MyChart. 

MyChart is a free, secure, online tool is available to all HHS patients and provides easy access to their hospital health record, and an opportunity to voluntarily provide personal information related to health equity.