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Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics.
Am J Respir Crit Care Med. 2008 Feb 01; 177(3):279-84.AJ

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.

Authors+Show Affiliations

Center for Research on Health Care, 200 Meyran Ave., Suite 200, Pittsburgh, PA 15213, USA. aeb2@pitt.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17975201

Citation

Barnato, Amber E., et al. "Racial Variation in the Incidence, Care, and Outcomes of Severe Sepsis: Analysis of Population, Patient, and Hospital Characteristics." American Journal of Respiratory and Critical Care Medicine, vol. 177, no. 3, 2008, pp. 279-84.
Barnato AE, Alexander SL, Linde-Zwirble WT, et al. Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics. Am J Respir Crit Care Med. 2008;177(3):279-84.
Barnato, A. E., Alexander, S. L., Linde-Zwirble, W. T., & Angus, D. C. (2008). Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics. American Journal of Respiratory and Critical Care Medicine, 177(3), 279-84.
Barnato AE, et al. Racial Variation in the Incidence, Care, and Outcomes of Severe Sepsis: Analysis of Population, Patient, and Hospital Characteristics. Am J Respir Crit Care Med. 2008 Feb 1;177(3):279-84. PubMed PMID: 17975201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics. AU - Barnato,Amber E, AU - Alexander,Sherri L, AU - Linde-Zwirble,Walter T, AU - Angus,Derek C, Y1 - 2007/11/01/ PY - 2007/11/3/pubmed PY - 2008/2/8/medline PY - 2007/11/3/entrez SP - 279 EP - 84 JF - American journal of respiratory and critical care medicine JO - Am J Respir Crit Care Med VL - 177 IS - 3 N2 - 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. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/17975201/Racial_variation_in_the_incidence_care_and_outcomes_of_severe_sepsis:_analysis_of_population_patient_and_hospital_characteristics_ L2 - https://www.atsjournals.org/doi/10.1164/rccm.200703-480OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -