Discrimination and systemic inflammation: A critical review and synthesis

Cuevas, Adolfo G.; Ong, Anthony D.; Carvalho, Keri; Ho, Thao; Chan, Sze Wan Celine; Allen, Jennifer D.; Chen, Ruijia; Rodgers, Justin; Biba, Ursula; Williams, David R.

doi:10.1016/j.bbi.2020.07.017

Cited by 116 publications

(74 citation statements)

References 98 publications

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“…This might occur for example because Black patients at baseline have higher creatinine levels than White patients, leading to an elevation of the renal component of the SOFA score unrelated to any illness [37]. Alternatively, Black persons with COVID-19 might have higher SOFA scores in the hospital because COVID-19 affects them more severely, for example because they are subjected to higher levels of discrimination and stress or because they have less access to long-term preventive care, quality education, economic stability, and other social determinants of health [23,24,38]. Finally, Black patients might have higher SOFA scores at the time of admission because they present or are admitted…”

Section: Plos Onementioning

confidence: 99%

Racial disparities in the SOFA score among patients hospitalized with COVID-19

et al. 2021

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Background Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. Research question Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? Study design and methods Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. Results Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11–1.99). Interpretation Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.

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Section: Plos Onementioning

confidence: 99%

Racial disparities in the SOFA score among patients hospitalized with COVID-19

et al. 2021

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“…Alternatively, Black persons with COVID-19 might have higher SOFA scores in the hospital because COVID-19 affects them more severely, for example because they are subjected to higher levels of discrimination and stress or because they have less access to long-term preventive care. (20, 21, 28) Finally, Black patients might have higher SOFA scores at the time of admission because they present or are admitted to hospitals only when they are sicker. (29, 30) This could be because of current or prior discrimination within the healthcare system that might discourage patients from seeking medical attention with mild or moderate symptoms.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in the SOFA Score Among Patients Hospitalized with COVID-19

Tolchin

Oladele

Galusha

et al. 2021

Preprint

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Background: Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care use SOFA score to allocate medical resources during the COVID-19 pandemic. Research Question: Are SOFA scores disproportionately elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? Study Design and Methods: Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcomes was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. Results: Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99). Interpretation: Crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.

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“…The findings also provide implications for identifying individuals who may be at increased risk of developing stress-related clinical disease outcomes as well as mortality. In terms of practical significance, a careful review of related research finds clear evidence from other studies showing that: (1) discrimination is associated with elevated CRP [ 67 ], (2) sleep is associated with elevated inflammation [ 1 ], and (3) chronic low-grade inflammation is associated with poor health outcomes [ 68 ]. Based on these converging lines of evidence, and informed by a population health perspective (e.g., Rose’s prevention paradox [ 69 ]), even small shifts in the distribution of a health metric (e.g., inflammation) can be expected to have meaningful impacts on the distribution of health in a population.…”

Section: Discussionmentioning

confidence: 99%

Linking discrimination and sleep with biomarker profiles: An investigation in the MIDUS study

Yip

Chen

Wang

et al. 2021

Comprehensive Psychoneuroendocrinology

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Self-reported experiences of discrimination and sleep dysfunction have both been shown to adversely impact biological functioning; however, few studies have examined how they are jointly associated with health. The current study draws from two samples of the Midlife in the United States (MIDUS) data (n = 617 participants; 59.8% female; 72.3% White and 27.7% African American; Age: Mean = 52.6, SD = 12.22) to identify profiles of sleep (duration, variability, onset latency, wake after sleep onset, naps) and discrimination (everyday, lifetime, impact). Associations with latent profiles of biomarkers of inflammation (CRP, fibrinogen, IL-6) and endocrine stress (cortisol, epinephrine, norepinephrine) were examined. Three profiles were identified for sleep/discrimination ( good, fair, poor ) and for biomarkers ( average, high inflammation, high neuroendocrine ). Chi-square analyses indicated that adults in the good sleep/low discrimination profile were more likely to be in the average biomarker profile but less likely to be in the high inflammation profile. Adults in the fair sleep/moderate discrimination risk profile were more likely to be in the high inflammation profile. Adults in the poor sleep/high discrimination risk profile were less likely to be in the average biomarker profile but more likely to be in the high inflammation profile. The current study identified configurations of sleep and discrimination among midlife adults which were associated with profiles of biological risk. The findings provide implications for identifying individuals who may be at increased risk of developing stress-related tertiary outcomes of morbidity and disease.

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Discrimination and systemic inflammation: A critical review and synthesis

Cited by 116 publications

References 98 publications

Racial disparities in the SOFA score among patients hospitalized with COVID-19

Racial disparities in the SOFA score among patients hospitalized with COVID-19

Racial Disparities in the SOFA Score Among Patients Hospitalized with COVID-19

Linking discrimination and sleep with biomarker profiles: An investigation in the MIDUS study

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