Downplay Sepsis at Your Peril

Race has a surprisingly strong effect on who contracts sepsis and who survives it. A new study shows that African-American patients are twice as susceptible to sepsis and are more likely to die compared to Caucasian patients. But Hispanics have a lower incidence of severe sepsis than Caucasians, and African-Americans die more frequently of severe sepsis than both Caucasians and Hispanics.

Researchers write, “The difference in incidence was evident by age 20 and continued throughout the adult lifespan. After accounting for differences in poverty and geography, black race remained independently associated with higher severe sepsis incidence.”

Lead authors Amber E. Barnato, MD, MPH, MS, of the Center for Research on Healthcare at the University of Pittsburgh, and Sherri L. Alexander, PhD, of Genentech offered their findings in the February 2008 issue of the American Journal of Respiratory and Critical Care Medicine.

Barnato and colleagues conducted a retrospective population-based analysis of race-specific incidence and ICU case fatality rates for hospital-based infection and severe sepsis in Florida, Massachusetts, New Jersey, New York, Virginia and Texas. Using demographic and socioeconomic data from the 2000 U.S. census and clinical data for hospitalized severe sepsis cases from the hospitals’ discharge data, they compared incidence of severe sepsis, ICU admission and ICU case fatality among races, controlling for age and gender. The total analysis included more than 71 million people.

“Blacks do indeed have a higher rate of severe sepsis — almost double that of whites,” wrote Barnato. “Some, but not all, of this increase was explained by blacks’ more frequent residence in ZIP codes with higher poverty rates, suggesting that social rather than biological determinants, such as health behavior and access to primary care, may contribute to this disparity,” Barnato continued. “In contrast, Hispanic ethnicity appeared protective, conditional on similar regional urbanicity and poverty.”