Dr. conducted Barnato and colleagues a retrospective population - based analysis of race-specific incidence and case fatality ICU rates for new-Jersey. New York. Virginia and Texas van Florida. Massachusetts. van de infection and severe sepsis in. hospital-based They obtained demographic census van and socioeconomic data from the 2000 U.S. and clinical data for severe data van sepsis cases from the hospitals' discharge. hospitalized They compared admission and ICU die case fatality van de incidence of severe sepsis. ICU among races. for age and gender. controlling 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 Dr. Barnato. „Some. but not all of thisincrease was explained by blacks' more frequent van poverty rates. suggesting that social. rather than biological determinants van residence in Postcodes with higher van such as health behavior. primary care. and access to may disparity.“ Dr. Barnato van contribute to this. continued "In contrast, Hispanic ethnicity appeared protective, conditional on similar regional urbanicity and poverty."
The investigators considered several possible explanations for their results, including racial variation in susceptibility to particular types of infections or organ dysfunction, and overall health at baseline. „However. the severe van among the groups with respect to van sepsis syndrome characteristics were not markedly different van infection. microbiologic etiology the site of organ dysfunction.“ wrote Dr. Barnato and both the number and type of. Furthermore. „the burden of substantially chronic racial groups.“ van de conditions among severe sepsis cases did not differ across
One factor that clearly differed among groups was the type of hospital facilities in which patients received care.
Blacks were more to be treated at de sepsis likely than whites van hospitals with poorer outcomes for severe. "If a black and white patient with the same clinical characteristics were treated at the same hospital, they would have identical case survival rates," said Dr. Barnato. "Therefore," she continued, "it may be that the hospitals that treat most black patients see black and white patients who are sicker than we can measure using these data sources, and/or that these hospitals are providing lower quality care."
Unmeasured study could van The not rule out het underlying van behavior. pharmaceutical use. van differencessuch as within-hospital variations in treatment by race that healthcare resources and may have to the fatality van differencesin case observed. nor could van basis for racial disparities van they dismiss the possibility of a biological van de susceptibility and outcome of severe sepsis. in important implications for treating sepsis.“ which could have „potentially contributed
Despite possible explanations for the racial disparities that could not be ruled out, Dr. Barnato points out that "the overall mortality disparity among blacks could be partially ameliorated by focused interventions to improve processes and outcomes of care at the hospitals that are disproportionately black." |
