Race Does Not Impact Sepsis Outcomes When Considering Socioeconomic Factors in Multilevel Modeling.
Crit Care Med
; 50(3): 410-417, 2022 03 01.
Article
in En
| MEDLINE
| ID: mdl-34259658
ABSTRACT
OBJECTIVES:
To determine whether race is a major determinant of sepsis outcomes when controlling for socioeconomic factors.DESIGN:
Retrospective cohort study.SETTING:
Barnes-Jewish Hospital a 1,350 bed academic medical center. PATIENTS Eleven-thousand four-hundred thirty-two patients hospitalized between January 2010 and April 2017 with sepsis and septic shock.INTERVENTIONS:
Multilevel random effects modeling was employed whereby patients were nested within ZIP codes. Individual patient characteristics and socioeconomic variables aggregated at the ZIP code level (education, employment status, income, poverty level, access to healthcare) were included in the model. MEASUREMENTS AND MAINRESULTS:
In hospital mortality, length of stay, need for vasopressors, and mechanical ventilation were the main endpoints. Black patients had more comorbidities than White patients except for cirrhosis and malignancy. In unadjusted comparisons, White individuals were more likely to require mechanical ventilation and had higher mortality rates and longer hospital stays for both low- and high-income groups. When nesting within ZIP codes and accounting for socioeconomic variables, race did not have a significant effect on mortality. Non-White races had lower odds ratio for mechanical ventilation.CONCLUSIONS:
Our study demonstrates that race is not an independent risk factor for sepsis mortality, as well as sepsis-related length of stay. We should expand our inquiry into determinants of sepsis outcomes by including socioeconomic variables.
Full text:
1
Collection:
01-internacional
Health context:
1_ASSA2030
/
2_ODS3
/
4_TD
Database:
MEDLINE
Main subject:
Severity of Illness Index
/
Sepsis
/
Racial Groups
/
Health Status Disparities
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Determinantes_sociais_saude
/
Equity_inequality
/
Patient_preference
Limits:
Humans
Language:
En
Journal:
Crit Care Med
Year:
2022
Document type:
Article