Disparities in Sepsis Outcomes: A Problem in Need of Solutions.
Disparities in Sepsis Outcomes: A Problem in Need of Solutions.
复制标题
败血症结果的差异：需要解决的问题。
DOI：
10.1097/ccm.0000000000004390
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发表时间：
2020
影响因子：
8.8
通讯作者：
Barbash,IanJ
中科院分区：
文献类型：
--
作者：
Barbash,IanJ
败血症每年影响超过一百万美国人，导致显著的发病率，死亡率和医疗保健支出（1，2）。正如美国几乎所有的医疗条件一样，败血症在人群中造成的公共卫生负担不均匀。生活在医疗服务不足地区的个人和来自特定社会经济群体的个人-包括种族和少数民族-患有不成比例的高败血症发病率和发病率（3）。一般来说，这些医疗差异来自于个体患者，提供者，医院和社会变量的复杂相互作用。解开脓毒症结果中社会经济差异的驱动因素是设计干预措施的关键先决条件，这将有助于减轻这些差异。大量文献表明，许多健康状况（包括脓毒症）结果差异的主要驱动因素是获得高质量护理的不平等，而不是遗传学，合并症或生活方式选择的差异（4，5）。与非少数民族背景的人相比，来自少数民族群体的人，特别是黑人患者，往往在不同的医院接受治疗。这些医院有时被称为“不成比例的少数民族”或“少数民族服务”医院，与其他医院相比，在一系列过程和结果测量中表现更差（6）。这些数据很重要，因为它们表明，我们在减轻脓毒症治疗和结局差异方面的成功可能取决于医院层面的组织干预，而不是针对个体患者或医生的干预。
Sepsis affects over one million Americans every year, resulting in significant morbidity, mortality, and healthcare spending (1, 2). As is true of nearly all medical conditions in the United States, sepsis imposes public health burdens unevenly across the population. Individuals who live in medically underserved areas and individuals from specific socioeconomic groups—including racial and ethnic minorities—suffer disproportionately high sepsis incidence and morbidity (3). In general, these healthcare disparities derive from a complex interplay of individual patient, provider, hospital, and societal variables. Disentangling the drivers of socioeconomic disparities in sepsis outcomes is a critical prerequisite to designing interventions that will help mitigate these disparities moving forward.A large body of literature suggests that a primary driver of disparities in outcomes from many health conditions, including sepsis, is unequal access to high-quality care, rather than differences in genetics, comorbidities, or lifestyle choices (4, 5). Individuals from racial minority groups—and in particular, patients of black race—tend to receive care at different hospitals than individuals from non-minority backgrounds. These hospitals, sometimes referred to as “disproportionately minority” or “minority serving” hospitals, perform worse across a range of process and outcome measures in comparison to other hospitals (6). These data are important because they suggest that our success in mitigating disparities in sepsis treatment and outcomes may hinge on organizational interventions at the hospital level, rather than interventions targeting individual patients or physicians.