Racial Disparities in Readmissions Following Initial Hospitalization for Sepsis
- 20 January 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 49 (3), e258-e268
- https://doi.org/10.1097/ccm.0000000000004809
Abstract
Objectives: To assess whether Black race is associated with a higher rate of all-cause readmission compared with White race following community-onset sepsis. Design: Retrospective cohort study. Setting: One-thousand three-hundred bed urban academic medical centers. Patients: Three-thousand three-hundred ninety patients hospitalized with community-onset sepsis between January 1, 2010, and December 31, 2017. Interventions: Community-onset sepsis was defined as patients admitted through the emergency department with an International Classification of Disease, ninth revision, Clinical Modification code for either severe sepsis (995.92) or septic shock (785.52). Beginning in 2015, we used International Classification of Disease, Tenth Revision, Clinical Modification codes R65.20 (severe sepsis) and R65.21 (septic shock). We excluded those individuals hospitalized at another acute care facility that were transferred to our facility. Race was abstracted electronically, and patients who expired or self-identified as a race other than Black or White race were excluded. Patients who experienced a subsequent hospitalization at our facility were considered to be readmitted. Measurements and Main Results: Compared with White race, Black race demonstrated a significantly higher rate of all-cause readmission (60.8% vs 71.1%; p < 0.001), including a higher rate of readmission for sepsis (14.0% vs 19.8%; p < 0.001). Black patients also resided in zip codes with a lower median household income and were more likely to use public insurance compared with White race. Similar rates of comorbid diseases and disease burden were observed between the two groups, but vasopressors were less likely to be administered to Black patients. Multivariable analysis showed that Black race was associated with a 50% increased odds (odds ratio, 1.52, 99% CI, 1.25–1.84) in all-cause readmission risk compared with White race. Conclusions: Black race was associated with a higher rate of all-cause and sepsis readmission, possibly as a result of unaddressed health disparities, compared with White race. Programs addressing healthcare disparities should use readmission as another marker of equity.This publication has 37 references indexed in Scilit:
- Benchmarking the Incidence and Mortality of Severe Sepsis in the United States*Critical Care Medicine, 2013
- Insurance and racial differences in long-term acute care utilization after critical illness*Critical Care Medicine, 2012
- The Influence of Race/Ethnicity and Socioeconomic Status on End-of-Life Care in the ICUSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2011
- The effect of race and ethnicity on outcomes among patients in the intensive care unit: A comprehensive study involving socioeconomic status and resuscitation preferences*Critical Care Medicine, 2011
- Racial and ethnic disparities in mortality from acute lung injury*Critical Care Medicine, 2009
- Racial Variation in the Incidence, Care, and Outcomes of Severe SepsisAmerican Journal of Respiratory and Critical Care Medicine, 2008
- The role of infection and comorbidity: Factors that influence disparities in sepsisCritical Care Medicine, 2006
- Prior Pneumococcal Vaccination Is Associated with Reduced Death, Complications, and Length of Stay among Hospitalized Adults with Community-Acquired PneumoniaClinical Infectious Diseases, 2006
- Novel Polymorphisms in the Myosin Light Chain Kinase Gene Confer Risk for Acute Lung InjuryAmerican Journal of Respiratory Cell and Molecular Biology, 2006
- African-American and white patients admitted to the intensive care unitCritical Care Medicine, 1995