Advertisement

Health Disparities and Sepsis: a Systematic Review and Meta-Analysis on the Influence of Race on Sepsis-Related Mortality

  • Panagis Galiatsatos
  • Junfeng Sun
  • Judith Welsh
  • Anthony Suffredini
Article
  • 45 Downloads

Abstract

Rationale

Racial disparities in sepsis outcomes have been previously reported. However, recently, there have been inconsistencies in identifying which socioeconomic variables, such as race, account for these disparities. The objective of this study was to perform a systematic review in order to examine the impact of race on sepsis-attributable mortality.

Methods

Systematic searches for English-language articles identified through MEDLINE, EBSCOhost, PubMed, ERIC, and Cochrane Library databases from 1960 to 1 February 2017. Included studies examined sepsis outcomes in the context of sepsis incidence and/or mortality. Two investigators independently extracted data and assessed study quality. The meta-analysis was performed in accordance with the Cochrane Collaboration guidelines.

Results

Twenty-one studies adhered to the predefined selection criteria and were included in the review. Of the 21 studies, we pooled data from 6 studies comparing African American/Black race as a risk factor for sepsis-related mortality disparities (reference group being Caucasian/White). From the meta-analysis on these six studies, African American/Black race was found to have no statistical significant relationship with sepsis-related mortality (odds ratio 1.20, 95% CI, 0.81 to 1.77). Similar results were found for other races (Native Americans, Asians) and ethnicities (Hispanic/Latinos).

Conclusion

On the basis of available evidence from a limited number of observation retrospective studies, race alone cannot fully explain sepsis-related disparities, especially sepsis-attributable mortality.

Keywords

Sepsis Race Mortality 

Notes

Compliance with Ethical Standards

Disclosure

The Intramural Research Programs of National Institutes of Health (Clinical Center, Critical Care Medicine Department) supported this work. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institutes of Health or the US Department of Health and Human Services.

Competing Interests

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347(20):1585–92.CrossRefPubMedGoogle Scholar
  2. 2.
    Barnato AE, Alexander SL, Linde-Zwirble WT, Angus DC. Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics. Am J Respir Crit Care Med. 2008;177(3):279–84.CrossRefPubMedGoogle Scholar
  3. 3.
    Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Cooke CR, Erickson SE, Eisner MD, Martin GS. Trends in the incidence of noncardiogenic acute respiratory failure: the role of race. Crit Care Med. 2012;40(5):1532–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chan PS, Nallamothu BK, Krumholz HM, Spertus JA, Li Y, Hammill BG, et al. Long-term outcomes in elderly survivors of in-hospital cardiac arrest. N Engl J Med. 2013;368(11):1019–26.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Haider AH, Chang DC, Efron DT, Haut ER, Crandall M, Cornwell EE 3rd. Race and insurance status as risk factors for trauma mortality. Arch Surg. 2008;143(10):945–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Schneider D, Lilienfeld DE, Im W. The epidemiology of pulmonary embolism: racial contrasts in incidence and in-hospital case fatality. J Natl Med Assoc. 2006;98(12):1967–72.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Mayr FB, Yende S, Linde-Zwirble WT, et al. Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis. JAMA. 2010;303(24):2495–503.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Moore JX, Donnelly JP, Griffin R, Safford MM, Howard G, Baddley J, et al. Black-white racial disparities in sepsis: a prospective analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Crit Care. 2015;19:279.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Winker MA. Measuring race and ethnicity: why and how? JAMA. 2004;292(13):1612–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Cooper RS, Kaufman JS, Ward R. Race and genomics. N Engl J Med. 2003;348(12):1166–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest. 1992;101(6):1481–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31(4):1250–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016;315(8):801–10.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376(23):2235–44.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Madsen TE, Napoli AM. Analysis of race and time to antibiotics among patients with severe sepsis or septic shock. J Racial Ethn Health Disparities. 2017;4(4):680-686.Google Scholar
  17. 17.
    Madsen TE, Simmons J, Choo EK, Portelli D, McGregor AJ, Napoli AM. The DISPARITY study: do gender differences exist in Surviving Sepsis Campaign resuscitation bundle completion, completion of individual bundle elements, or sepsis mortality? J Crit Care. 2014;29(3):473.e477–11.CrossRefGoogle Scholar
  18. 18.
    Higgins JP, Green S. Cochrane Handbook for systematic reviews of interventions. Version 4.2.6. The Cochrane Collaboration. 2006. https://training.cochrane.org/handbook. Accessed 1 May 2018.
  19. 19.
    R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2017.Google Scholar
  20. 20.
    Schwarzer G. Meta: an R package for meta-analysis. R News. 2007;7(3):40–5.Google Scholar
  21. 21.
    Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefGoogle Scholar
  22. 22.
    Bime C, Poongkunran C, Borgstrom M, Natt B, Desai H, Parthasarathy S, et al. Racial differences in mortality from severe acute respiratory failure in the United States, 2008-2012. Ann Am Thorac Soc. 2016;13(12):2184–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Cribbs SK, Tse C, Andrews J, Shenvi N, Martin GS. Characteristics and outcomes of HIV-infected patients with severe sepsis: continued risk in the post-highly active antiretroviral therapy era. Crit Care Med. 2015;43(8):1638–45.CrossRefPubMedGoogle Scholar
  24. 24.
    Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129(6):1432–40.CrossRefPubMedGoogle Scholar
  25. 25.
    Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Occurrence and outcomes of sepsis: influence of race. Crit Care Med. 2007;35(3):763–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: factors that influence disparities in sepsis. Crit Care Med. 2006;34(10):2576–82.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Goodwin AJ, Nadig NR, McElligott JT, Simpson KN, Ford DW. Where you live matters: the impact of place of residence on severe sepsis incidence and mortality. Chest. 2016;150(4):829–36.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kumar G, Taneja A, Majumdar T, Jacobs ER, Whittle J, Nanchal R. The association of lacking insurance with outcomes of severe sepsis: retrospective analysis of an administrative database*. Crit Care Med. 2014;42(3):583–91.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Bedri H, Romanowski KS, Al-Ramahi G, et al. A national study of the effect of race, socioeconomic status, and gender on burn outcomes. J Burn Care Res. 2017;38(3):161–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Cheek JE, Holman RC, Redd JT, Haberling D, Hennessy TW. Infectious disease mortality among American Indians and Alaska Natives, 1999-2009. Am J Public Health. 2014;104(Suppl 3):S446–52.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Firempong AO, Shaheen MA, Pan D, Drazin D. Racial and ethnic disparities in the incidence and mortality from septic shock and respiratory failure among elective neurosurgery patients. Neurol Res. 2014;36(10):857–65.CrossRefPubMedGoogle Scholar
  32. 32.
    Melamed A, Sorvillo FJ. The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care. 2009;13(1):R28.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Plurad DS, Lustenberger T, Kilday P, et al. The association of race and survival from sepsis after injury. Am Surg. 2010;76(1):43–7.PubMedGoogle Scholar
  34. 34.
    Sandoval E, Chang DW. Association between race and case fatality rate in hospitalizations for sepsis. J Racial Ethn Health Disparities. 2016;3(4):625–34.CrossRefPubMedGoogle Scholar
  35. 35.
    Vogel TR, Dombrovskiy VY, Lowry SF. Trends in postoperative sepsis: are we improving outcomes? Surg Infect. 2009;10(1):71–8.CrossRefGoogle Scholar
  36. 36.
    Moore JX, Donnelly JP, Griffin R, Howard G, Safford MM, Wang HE. Defining sepsis mortality clusters in the United States. Crit Care Med. 2016;44(7):1380–7.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Xavier Moore J, Donnelly JP, Griffin R, et al. Community characteristics and regional variations in sepsis. Int J Epidemiol. 2017;46(5):1607–17.CrossRefPubMedGoogle Scholar
  38. 38.
    Sammon JD, Klett DE, Sood A, Olugbade K Jr, Schmid M, Kim SP, et al. Sepsis after major cancer surgery. J Surg Res. 2015;193(2):788–94.CrossRefPubMedGoogle Scholar
  39. 39.
    Lander ES, Linton LM, Birren B, et al. Initial sequencing and analysis of the human genome. Nature. 2001;409(6822):860–921.CrossRefPubMedGoogle Scholar
  40. 40.
    Wilson JF, Weale ME, Smith AC, Gratrix F, Fletcher B, Thomas MG, et al. Population genetic structure of variable drug response. Nat Genet. 2001;29(3):265–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Sankar P, Cho MK. Genetics. Toward a new vocabulary of human genetic variation. Science. 2002;298(5597):1337–8.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Isaacs SL, Schroeder SA. Class - the ignored determinant of the nation’s health. N Engl J Med. 2004;351(11):1137–42.CrossRefPubMedGoogle Scholar
  43. 43.
    Becker LB, Han BH, Meyer PM, Wright FA, Rhodes KV, Smith DW, et al. Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. N Engl J Med. 1993;329(9):600–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Jha AK, Orav EJ, Li Z, Epstein AM. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med. 2007;167(11):1177–82.CrossRefPubMedGoogle Scholar
  45. 45.
    Werner RM, Goldman LE, Dudley RA. Comparison of change in quality of care between safety-net and non-safety-net hospitals. Jama. 2008;299(18):2180–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Virnig BA, Lurie N, Huang Z, Musgrave D, McBean AM, Dowd B. Racial variation in quality of care among Medicare+Choice enrollees. Health Aff (Millwood). 2002;21(6):224–30.CrossRefGoogle Scholar
  47. 47.
    National Research Council. 2004. Critical Perspectives on Racial and Ethnic Differences in Health in Late Life. Washington, DC: The National Academies Press.  https://doi.org/10.17226/11086. Accessed 30 March 2018.
  48. 48.
    Wagle UR. Multidimensional poverty: an alternative measurement approach for the United States? Soc Sci Res. 2008;37(2):559–80.CrossRefPubMedGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Critical Care Medicine Department, Clinical CenterNational Institutes of HealthBethesdaUSA
  3. 3.Medicine for the Greater Good at Johns Hopkins School of MedicineBaltimoreUSA
  4. 4.Office of Research Services, NIH LibraryNational Institutes of HealthBethesdaUSA

Personalised recommendations