As the cost of modern healthcare increases, sepsis remains one of the most clinically complex and expensive diagnoses. This study investigated the correlation between sepsis-related charges, trauma center designation, and region-specific socioeconomic factors across the United States (US). A retrospective observational study was conducted using deidentified data from the Healthcare Cost and Utilization Project (HCUP). Sepsis was defined by the following ICD-10 codes: A41.9, A41.81, A41.89, R65.20, and R65.21. The analytic dataset comprised all US adult inpatient hospitalizations with a sepsis diagnosis from January 2019 through December 2021 (n = 1,807,958). Linear Mixed Models assessed longitudinal patterns in total charges, while between-subjects ANOVAs compared mean differences across patient demographics and hospital characteristics. Sepsis cases increased concurrently with the COVID-19 pandemic (2020–2021). Results indicated that emergency department (ED) sepsis charges were significantly influenced by the intersection of regional context, hospital trauma designation, and neighborhood socioeconomic status (n=620,540, p-value <0.001). Level I trauma centers consistently reported the lowest adjusted charges across all years (2019: $4871; 2020: $4495; 2021: $5387), while non-trauma and Level III centers reported the highest (2019: $6032 and $5964; 2021: $6919 and $6796). Geographically, adjusted mean charges were highest in the West and lowest in the Northeast. These findings suggest that hospital charges are heavily influenced by median income and regional location, highlighting systemic disparities where socioeconomic markers may be greater determinants of healthcare costs than clinical severity alone. While this study identifies significant cost disparities, it is limited by reliance on administrative billing data, which may not capture granular clinical nuances or specific bedside rationing. Future research should integrate clinical outcomes data to determine if these cost variations correlate with differences in quality of care or patient mortality across diverse socioeconomic strata.
