Yasmin Herrera
Icahn School of Medicine at Mount Sinai
New York, NY
Disclosure information not submitted.
Edith T Robin, MD
Physician, Department of Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Maria Riego, MD
Resident, Department of Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Nobel Chowdhury, MD
Resident Physician, Department of Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Raymond A Jean, MD
Resident, Department of Surgery
Yale University, United States
Disclosure information not submitted.
Raymonde Jean, MD
Associate Professor, Department of Critical Care and Pulmonary Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Title: Racial Disparities in Inpatient Mortality among Patients Admitted with Pneumonia and Severe Sepsis
Introduction: Each year, 1.7 million adults develop sepsis across the country. Although mortality rates are declining, sepsis continues to be a common cause of inpatient deaths. Previous studies suggest variation in sepsis-related suffering among different races. Our study aimed to look at these racial disparities among hospitalized patients with pneumonia (PNA) and severe sepsis and its effect on mortality.
Methods: The National Inpatient Sample between 2014 and 2017 was analyzed for patients admitted with PNA and a primary diagnosis of severe sepsis. We compared annual trends in inpatient death across race and ethnicity. We performed an adjusted logistic regression to estimate the effect of race on mortality adjusted for other demographic and clinical factors, including sex, age, Charlson comorbidity, income quartile, and insurance status.
Results: There were 2,878,965 admissions during the study period. Overall inpatient mortality over the study period was 15.1%, which showed a steady decline from 17.0% in 2014 to 14.0% in 2017 (p < 0.0001 for trend). The highest mortality was observed among patients classified as other, with an overall mortality of 17.5%. Among patients with defined racial groups, the greatest mortality was observed among Asians and Pacific Islanders, with an overall mortality of 17.0%, which declined from 19.5% in 2014 to 15.8% in 2017. The lowest overall mortality was observed among White patients, with an overall mortality of 14.8% that decreased from 16.7% in 2014 to 13.8% in 2017. Despite this, when adjusting for other factors, other (OR 1.27, 95%CI 1.25-1.29) and black race (OR 1.16, 95%CI 1.15-1.17) had the highest association with mortality in comparison to white race.
Conclusion: There has been a steady decline in mortality of patients with PNA across all racial groups. In this study, analysis shows that although Asians and Pacific Islanders had the highest unadjusted mortality, Black race was associated with the highest adjusted odds of mortality. This study illustrates that standardized treatment may not suffice in treating sepsis. Efforts towards education, support of at-risk and underserved communities are necessary. Further studies should aim to recognize any preventable factors and personalization of treatment that contribute to racial disparities in sepsis care and outcome.