Reasons for Higher Rate of Severe Sepsis in Black Patients Identified

A new study suggests that a higher infection rate and higher risk for acute organ dysfunction may explain racial differences in severe sepsis.

Researchers at the University of Pittsburgh (PA, USA) conducted a large, retrospective cohort study of infection-related hospitalizations from the 2005 hospital discharge data of 7 U.S. states, and infection-related emergency department (ED) visits from the 2003-2007 U.S. National Hospital Ambulatory Care Survey. The main outcome measure was age- and sex-standardized severe sepsis and infection hospitalization rates, and the risk of acute organ dysfunction.

The results of the study showed that of 8,661,227 non-childbirth-related discharges, 2,261,857 were associated with an infection, and of these, 381,787 (16.8%) had severe sepsis. Black patients had a 67% higher age- and sex-standardized severe sepsis rate than did white patients and 80% higher standardized mortality. The higher severe sepsis rate in black patients was explained by the researchers as resulting from both a higher infection rate and a higher risk of developing acute organ dysfunction. Differences in infection presented broadly across different sites and etiology of infection and for community- and hospital-acquired infections, and occurred despite a lower likelihood of being admitted for infection from the ED. The higher risk of organ dysfunction persisted but it was attenuated after adjusting for age, sex, comorbid conditions, poverty, and hospital effect. The racial disparities in infection and severe sepsis incidence and mortality rates were largest among younger adults. The study was published in the June 23, 2010 issue of the Journal of the American Medical Association (JAMA).

"Reducing these racial disparities will require community-based interventions, such as vaccination, improved management of chronic diseases, and hospital-based interventions targeted especially to hospitals that serve large proportions of black patients,” concluded lead author Florian Mayr, M.D., M.P.H, and colleagues from the department of critical care medicine. "Current guidelines for pneumococcal vaccination, one of the largest and most effective strategies to prevent severe sepsis, do not target up to 25% of cases among blacks.”

Sepsis is a serious medical condition that is characterized by a systemic inflammatory response syndrome (SIRS) and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues.

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