Treatment in Disproportionately Minority Hospitals Is Associated With Increased Risk of Mortality in Sepsis: A National Analysis.
Treatment in Disproportionately Minority Hospitals Is Associated With Increased Risk of Mortality in Sepsis: A National Analysis.
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DOI：
10.1097/ccm.0000000000004375
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发表时间：
2020-07
影响因子：
8.8
通讯作者：
Celi LA
中科院分区：
文献类型：
--
作者：
Rush B;Danziger J;Walley KR;Kumar A;Celi LA
在不成比例的少数服务医院接受治疗与各种疾病的不良后果有关。我们研究了在美国不成比例的少数医院治疗与脓毒症患者结局的相关性。回顾性队列分析来自2008-2014年的全国住院患者样本不对称少数民族医院被定义为相对少数民族患者人数是周围地理平均值的两倍的医院。根据美国人口普查的人口统计信息，确定了黑人和西班牙裔患者人群的少数民族医院。采用一种多变量模型，该模型采用经验证的算法，使用管理数据计算脓毒症死亡率。共确定了4，221，221例脓毒症患者。其中，612，217名（14.5%）患者在为黑人社区服务的医院（黑人医院）接受治疗，而181，141名（4.3%）患者在为西班牙裔社区服务的医院（西班牙裔医院）接受治疗。多变量分析后，在黑人医院治疗与非少数民族医院治疗相比，死亡风险高4%（OR 1.04，95%CI 1.03-1.05，p<0.01）。在西班牙裔医院接受治疗与死亡风险增加9%相关（OR 1.09，95%CI 1.07-1.11，p<0.01）。在不成比例的少数民族医院中，每个医院的中位住院时间几乎长1天（非少数民族医院为5.9天，IQR 3.1-11.0，西班牙裔为6.9天，黑人为6.7天，IQR 3.4-13.2，均p<0.01）。在少数民族医院接受治疗的败血症患者，无论种族如何，其院内死亡率都显着较高。
Treatment in a disproportionately minority serving hospital has been associated with worse outcomes in a variety of illnesses. We examined the association of treatment in disproportionately minority hospitals on outcomes in patients with sepsis across the United States. Retrospective Cohort Analysis The National Inpatient Sample from 2008–2014 Disproportionately minority hospitals were defined as hospitals having twice the relative minority patient population than the surrounding geographical mean. Minority hospitals for Black and Hispanic patient populations were identified based on US Census demographic information. A multivariate model employing a validated algorithm for mortality in sepsis using administrative data was utilized. None A total of 4,221,221 patients with sepsis were identified. Of these, 612,217 (14.5%) patients were treated at hospitals disproportionately serving the black community (Black hospitals) while 181,141 (4.3%) were treated at hospitals disproportionately serving the Hispanic community (Hispanic hospitals). After multivariate analysis, treatment in a Black hospital was associated with a 4% higher risk of mortality compared to treatment in a non-minority hospital (OR 1.04, 95% CI 1.03–1.05, p<0.01). Treatment in a Hispanic hospital was associated with a 9% higher risk of mortality (OR 1.09, 95% CI 1.07–1.11, p<0.01). Median hospital length of stay was almost 1 day longer at each of the disproportionately minority hospitals (5.9 days IQR 3.1–11.0 Non-Minority Hospitals vs 6.9 days IQR 3.6–12.9 Hispanic and 6.7 days IQR 3.4–13.2 Black, both p<0.01). Patients with sepsis regardless of race who were treated in disproportionately high minority hospitals suffered significantly higher rates of in-hospital mortality.