Cited by 285Sepsis Diagnosis and TreatmentHealth disparities and outcomesNeonatal and Maternal Infections

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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

DOI 10.1164/rccm.200703-480ocPMC PMC2720103

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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
ORCID: Barnato, Amber E.
Angus, Derek C.
Venue: American Journal of Respiratory and Critical Care Medicine
Publisher: Oxford University Press (OUP)
Published: 2008-02-01
Volume: 177
Issue: 3
Pages: 279-284
ISSN: 1073-449X (ISSN-L)
1535-4970
DOI: 10.1164/rccm.200703-480oc
PMC: PMC2720103
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: green
www.ncbi.nlm.nih.gov
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
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 › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Social Sciences › Health › Health disparities and outcomes
Health Sciences › Medicine › Pediatrics, Perinatology and Child 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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Racial Variation in the Incidence, Care, and Outcomes of Severe Sepsis

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