Racial Disparities in Sepsis-Related In-Hospital Mortality: Using a Broad Case Capture Method and Multivariate Controls for Clinical and Hospital Variables, 2004–2013

Jones, Jenna M.; Fingar, Kathryn R.; Miller, Melissa A.; Coffey, Rosanna M.; Barrett, Marguerite L; Flottemesch, Thomas J.; Heslin, Kevin C.; Gray, Darryl T.; Moy, Ernest

doi:10.1097/ccm.0000000000002699

Cited by 51 publications

(41 citation statements)

References 24 publications

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“…Between varieties of different hospital admission causes, the black race has historically been associated with lower resource utilization and higher in-hospital mortality [10][11][12][20][21][22]. However, among frail patients in our study, the white race was the strongest racial predictor of inpatient mortality.…”

Section: Discussioncontrasting

confidence: 49%

Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention

Desai

Amraotkar

et al. 2019

Cureus

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To study the impact of frailty on inpatient outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods The National Inpatient Sample data of all PCI-related hospitalizations throughout the United States (US) from 2010 through 2014 was utilized. Patients were divided into two groups: frailty and no-frailty. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to stratify groups and outcomes. In order to address the substantial difference in the total number of valid observations between the two groups, a propensity-matched analysis was performed at a 1:1 ratio and caliper width of 0.01.

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Section: Discussioncontrasting

confidence: 49%

Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention

Desai

Amraotkar

et al. 2019

Cureus

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“…This approach has been suggested as the best way to operationalize these variables 29 and has been utilized by similar studies in the literature. 9,14,15 We considered the Asian race to include all people of East Asian, Southeast Asian, or South Asian descent, which is consistent with the United States Census Bureau definition. 30 Patients identifying as Native Hawaiians/Pacific Islanders, Native Americans/Alaskan Natives, as well as those with unspecified race or ethnicity, were categorized as Other.…”

Section: Covariate Data Collectionmentioning

confidence: 99%

The Association between Limited English Proficiency and Sepsis Mortality

Jacobs

Prasad

Fang

et al. 2019

Journal of Hospital Medicine

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BACKGROUND: Limited English proficiency (LEP) has been implicated in poor health outcomes. Sepsis is a frequently fatal syndrome that is commonly encountered in hospital medicine. The impact of LEP on sepsis mortality is not currently known. OBJECTIVE: To determine the association between LEP and sepsis mortality. DESIGN: Retrospective cohort study. SETTING: 800-bed, tertiary care, academic medical center. PATIENTS: Electronic health record data were obtained for adults admitted to the hospital with sepsis between June 1, 2012 and December 31, 2016. MEASUREMENTS: The primary predictor was LEP. Patients were defined as having LEP if their self-reported primary language was anything other than English and interpreter services were required during hospitalization. The primary outcome was inpatient mortality. Mortality was compared across races stratified by LEP using chi-squared tests of significance. Bivariable and multivariable logistic regressions were performed to investigate the association between mortality, race, and LEP, adjusting for baseline characteristics, comorbidities, and illness severity. RESULTS: Among 8,974 patients with sepsis, we found that 1 in 5 had LEP, 62% of whom were Asian. LEP was highly associated with death across all races except those identifying as Black and Latino. LEP was associated with a 31% increased odds of mortality after adjusting for illness severity, comorbidities, and other baseline characteristics, including race (OR 1.31, 95% CI 1.06-1.63, P = .02). CONCLUSIONS: In a single-center study of patients hospitalized with sepsis, LEP was associated with mortality across nearly all races. This is a novel finding that will require further exploration into the causal nature of this association.

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“…Several studies have suggested that inter-hospital differences play a significant role in racial disparities of sepsis management. Minority patients are more likely to be treated at safety net hospitals and urban teaching hospitals, which often experience increased financial constraints while treating diverse patient populations [18,23,44,62,63]. Mayr and colleagues found that hospitals that treated higher proportions of black patients were less likely to receive antibiotics within 4 hours for pneumonia (odds ratio (OR) of 0.72 relative to whites) [63].…”

Section: Hospital-based Factorsmentioning

confidence: 99%

Factors Underlying Racial Disparities in Sepsis Management

et al. 2018

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Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, a wide variability in clinical outcomes persists across racial groups. Specifically, black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the white population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis.

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Racial Disparities in Sepsis-Related In-Hospital Mortality: Using a Broad Case Capture Method and Multivariate Controls for Clinical and Hospital Variables, 2004–2013

Cited by 51 publications

References 24 publications

Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention

Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention

The Association between Limited English Proficiency and Sepsis Mortality

Factors Underlying Racial Disparities in Sepsis Management

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