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Blacks twice as
susceptible and more likely to die of severe
Sepsis than Whites
Newswise — Blacks have
almost double the rate of severe sepsis—an
overwhelming infection of the bloodstream
accompanied by acute organ dysfunction—as
whites, according to recent research.
“The difference in incidence was evident by
age 20 and continued throughout the adult
lifespan.
"After
accounting for differences in poverty and
geography, black race remained independently
associated with higher severe sepsis
incidence,” wrote lead authors Amber E.
Barnato, M.D., M.P.H., M.S., of the Center
for Research on Health Care at the
University of Pittsburgh, and Sherri L.
Alexander, Ph.D., of Genentech. Hispanics,
on the other hand, have a lower incidence of
severe sepsis than whites.
What is more, blacks
die more frequently of severe sepsis that
either whites or Hispanics.
The findings appear in the first issue for
February of the American Journal of
Respiratory and Critical Care Medicine,
published by the American Thoracic Society.
Dr. Barnato and colleagues conducted a
retrospective population-based analysis of
race-specific incidence and ICU case
fatality rates for hospital-based infection
and severe sepsis in Florida, Massachusetts,
New Jersey, New York, Virginia and Texas.
They obtained
demographic and socioeconomic data from the
2000 U.S. census and clinical data for
hospitalized severe sepsis cases from the
hospitals’ discharge data.
They compared incidence
of severe sepsis, ICU admission and ICU case
fatality among races, controlling for age
and gender. The total analysis included more
than 71 million people.
“Blacks do indeed have a higher rate of
severe sepsis—almost double that of whites,”
wrote Dr. Barnato.
“Some, but not all of
this increase was explained by blacks’ more
frequent residence in ZIP codes with higher
poverty rates, suggesting that social,
rather than biological determinants, such as
health behavior and access to primary care,
may contribute to this disparity,” Dr.
Barnato continued.
“In contrast, Hispanic
ethnicity appeared protective, conditional
on similar regional urbanicity and poverty.”
The investigators considered several
possible explanations for their results,
including racial variation in susceptibility
to particular types of infections or organ
dysfunction, and overall health at baseline.
“However, the severe
sepsis syndrome characteristics were not
markedly different among the groups with
respect to the site of infection,
microbiologic etiology and both the number
and type of organ dysfunction,” wrote Dr.
Barnato.
Furthermore, “the
burden of chronic conditions among severe
sepsis cases did not differ substantially
across racial groups.”
One factor that clearly differed among
groups was the type of hospital facilities
in which patients received care.
Blacks were more likely to be treated at
hospitals with poorer outcomes for severe
sepsis than whites.
“If a black and white
patient with the same clinical
characteristics were treated at the same
hospital, they would have identical case
survival rates,” said Dr. Barnato.
“Therefore,” she
continued, “it may be that the hospitals
that treat most black patients see black and
white patients who are sicker than we can
measure using these data sources, and/or
that these hospitals are providing lower
quality care.”
The study could not
rule out unmeasured underlying differences
such as behavior, pharmaceutical use,
healthcare resources and within-hospital
variations in treatment by race that may
have contributed to the differences in case
fatality observed, nor could they dismiss
the possibility of a biological basis for
racial disparities in susceptibility and
outcome of severe sepsis, which could have
“potentially important implications for
treating sepsis.”
Despite possible explanations for the racial
disparities that could not be ruled out, Dr.
Barnato points out that “the overall
mortality disparity among blacks could be
partially ameliorated by focused
interventions to improve processes and
outcomes of care at the hospitals that are
disproportionately black.”
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