Cited by 284Sepsis Diagnosis and TreatmentHealth disparities and outcomesNeonatal and Maternal Infections

Racial Variation in the Incidence, Care, and Outcomes of Severe Sepsis

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Barnato, Amber E., Alexander, Sherri L., Linde-Zwirble, Walter T., Angus, Derek C.·2008·American Journal of Respiratory and Critical Care Medicine

Abstract

Rationale: Higher rates of sepsis have been reported in minorities. Objectives: To explore racial differences in the incidence and associated case fatality of severe sepsis, accounting for clinical, social, health care service delivery, and geographic characteristics. Methods: Retrospective population-based cohort study using hospital discharge and U.S. Census data for all persons (n = 71,102,655) living in 68 hospital referral regions in six states. Measurements and Main Results: Age-, sex- and race-standardized severe sepsis incidence and inpatient case fatality rates, adjusted incidence rate ratios, and adjusted intensive care unit (ICU) admission and case fatality rate differences. Of 8,938,111 nonfederal hospitalizations, 282,292 had severe sepsis. Overall, blacks had the highest age- and sex-standardized population-based incidence (6.08/1,000 vs. 4.06/1,000 for Hispanics and 3.58/1,000 for whites) and ICU case fatality (32.1 vs. 30.4% for Hispanics and 29.3% for whites, P < 0.0001). Adjusting for differences in poverty in their region of residence, blacks still had a higher population-based incidence of severe sepsis (adjusted rate ratio, 1.44 [95% CI, 1.42–1.46]) than whites, but Hispanics had a lower incidence (adjusted rate ratio, 0.91 [0.90–0.92]). Among patients with severe sepsis admitted to the ICU, adjustments for clinical characteristics and the treating hospital fully explained blacks' higher ICU case fatality. Conclusions: Higher adjusted black incidence and the lower Hispanic incidence may reflect residual confounding, or it could signal biologic differences in susceptibility. Focused interventions to improve processes and outcomes of care at the hospitals that disproportionately treat blacks could narrow disparities in overall mortality from severe sepsis.

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Authors
Barnato, A. E., Alexander, S. L., Linde-Zwirble, W. T., & Angus, D. C.
Affiliations
  • University of Pittsburgh (US)
  • Genentech (US)
  • ZD Associates, LLC, Perkasie, Pennsylvania
Venue
American Journal of Respiratory and Critical Care Medicine
Published
2008-02-01
Volume
177
Issue
3
Pages
279-284
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
OpenAlex
W2000321839
Cited by
284
References
31
Citations by year
2026: 15 · 2025: 19 · 2024: 16 · 2023: 23 · 2022: 22 · 2021: 14 · 2020: 13 · 2019: 16 · 2018: 14 · 2017: 13 · 2016: 24 · 2015: 12 · 2014: 6 · 2013: 8 · 2012: 18
FWCI
9.21
Type
journal article
Language
en
Open access
Locations
  • American Journal of Respiratory and Critical Care Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute on Aging (K08 AG 21921, K08AG021921)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
Keywords
severe sepsis, racial disparities, Black patients, Hispanic patients, case fatality, sepsis incidence, intensive care unit admission, poverty, health care disparities, residual confounding, hospital quality of care
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Black or African American, Child, Child, Preschool, Critical Care, Female, Hispanic or Latino, Hospital Bed Capacity, Hospitals, Teaching, Hospitals, Urban, Humans, Infant, Infant, Newborn, Intensive Care Units, Male, Middle Aged, Practice Patterns, Physicians', Retrospective Studies, United States, Cohort Studies, Incidence, Sepsis, White People, Health Status Disparities, Healthcare Disparities

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