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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

Jones, Jenna M. PhD1; Fingar, Kathryn R. PhD1; Miller, Melissa A. MD2; Coffey, Rosanna PhD1; Barrett, Marguerite MS3; Flottemesch, Thomas PhD1; Heslin, Kevin C. PhD2; Gray, Darryl T. MD2; Moy, Ernest MD4

doi: 10.1097/CCM.0000000000002699
Online Clinical Investigations

Objectives: As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. The effect of other patient and hospital characteristics on disparities in sepsis mortality is not yet well-known. Furthermore, coding practices in claims data may influence findings. The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004–2013 trends in risk-adjusted in-hospital sepsis mortality rates by race/ethnicity to inform efforts to reduce disparities in sepsis deaths.

Design: Retrospective, repeated cross-sectional study.

Setting: Acute care hospitals in the Healthcare Cost and Utilization Project State Inpatient Databases for 18 states with consistent race/ethnicity reporting.

Patients: Patients diagnosed with septicemia, sepsis, organ dysfunction plus infection, severe sepsis, or septic shock.

Measurements and Main Results: In-hospital sepsis mortality rates adjusted for patient and hospital factors by race/ethnicity were calculated. From 2004 to 2013, sepsis hospitalizations for all racial/ethnic groups increased, and mortality rates decreased by 5–7% annually. Mortality rates adjusted for patient characteristics were higher for all minority groups than for white patients. After adjusting for hospital characteristics, sepsis mortality rates in 2013 were similar for white (92.0 per 1,000 sepsis hospitalizations), black (94.0), and Hispanic (93.5) patients but remained elevated for Asian/Pacific Islander (106.4) and “other” (104.7; p < 0.001) racial/ethnic patients.

Conclusions: Our results indicate that hospital characteristics contribute to higher rates of sepsis mortality for blacks and Hispanics. These findings underscore the importance of ensuring that improved sepsis identification and management is implemented across all hospitals, especially those serving diverse populations.

1Truven Health Analytics, an IBM Company, Bethesda, MD.

2Agency for Healthcare Research and Quality, Rockville, MD.

3M.L. Barrett, Del Mar, CA.

4National Center for Health Statistics, Hyattsville, MD.

Supported, in part, by the Agency for Healthcare Research and Quality Contract No. HHSA-290-2013-00002-C.

The views expressed herein are those of the authors and do not necessarily reflect those of the Agency for Healthcare Research and Quality, The National Center for Health Statistics and the Centers for Disease Control and Prevention, or the U.S. Department of Health and Human Services.

Drs. Jones, Fingar, Miller, Coffey, Heslin, Gray, and Moy disclosed government work. Drs. Jones, Coffey, and Flottemesch’s institutions received funding from the Agency for Healthcare Research and Quality (AHRQ) Contract No. HHSA-290-2013-00002-C. Drs. Fingar and Miller received support for article research from the AHRQ. Ms. Barrett disclosed work for hire.

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