Association Between Race and Case Fatality Rate in Hospitalizations for Sepsis.

Abstract

Differentiating whether disparities in outcomes for sepsis among racial groups are due to differences in hospital care versus pre-hospitalization factors is an important step in developing effective strategies to reduce these disparities. As such, we examined the association between race and case fatality rates among hospitalizations for sepsis. This was a case-control study of hospitalizations for sepsis in all acute-care, non-federal California hospitals during 2011. The association between hospital mortality and race was examined using hierarchical logistic regression analysis. Among 131,831 hospitalizations for sepsis, the unadjusted case fatality rates were 15.1% in whites, 14.0% in blacks, 13.8% in Hispanics, and 16.2% in Asians (P<0.001). Compared to whites, the odds of hospital mortality was 0.84 (95% CI 0.79-0.89) for blacks, 0.88 (95% CI 0.84-0.92) for Hispanics, and 0.93 (95% CI 0.87-0.98) for Asians after controlling for patient, healthcare systems, and hospital-level factors. There was no difference in the variability of sepsis mortality across hospitals between racial groups. The range of case fatality rates for sepsis among hospitals was 8.3-22.9% for whites, 9.1-20.5% for blacks, 7.0-19.1% for Hispanics, and 10.0-23.0% for Asians. Case fatality rates for sepsis hospitalizations are lower in minority racial groups in California. Future studies and interventions that seek to reduce racial disparities in sepsis need to focus on pre-hospitalization factors that contribute to population-level racial differences in sepsis outcomes.