Race Does Not Impact Sepsis Outcomes When Considering Socioeconomic Factors in Multilevel Modeling.
Race Does Not Impact Sepsis Outcomes When Considering Socioeconomic Factors in Multilevel Modeling.
复制标题
DOI：
10.1097/ccm.0000000000005217
复制
发表时间：
2022-03-01
影响因子：
8.8
通讯作者：
Micek, Scott T.
中科院分区：
文献类型：
--
作者：
Guillamet, M. Cristina Vazquez;Dodda, Sai;Liu, Lei;Kollef, Marin H.;Micek, Scott T.
在控制社会经济因素的情况下，确定种族是否是脓毒症结局的主要决定因素。回顾性队列研究。巴恩斯犹太医院拥有1350张床位的学术医疗中心。2010年1月至2017年4月期间，有11432名患者因败血症和感染性休克住院。采用多层随机效应模型，将患者嵌套在邮政编码内。在邮政编码水平上汇总的个体患者特征和社会经济变量（教育、就业状况、收入、贫困水平、获得医疗保健的机会）被纳入模型。住院死亡率、住院时间、血管加压药物的需求和机械通气是主要终点。除肝硬化和恶性肿瘤外，黑人患者的合并症多于白人患者。在未经调整的比较中，白人更有可能需要机械通气，低收入和高收入群体的死亡率更高，住院时间更长。当在邮政编码内嵌套并考虑社会经济变量时，种族对死亡率没有显著影响。非白种人使用机械通气的优势比较低。我们的研究表明，种族不是脓毒症死亡率的独立危险因素，以及脓毒症相关的住院时间。我们应该通过纳入社会经济变量来扩大对败血症结果决定因素的调查。
To determine whether race is a major determinant of sepsis outcomes when controlling for socioeconomic factors. Retrospective cohort study. Barnes-Jewish Hospital a 1,350 bed academic medical center. Eleven-thousand four-hundred thirty-two patients hospitalized between January 2010 and April 2017 with sepsis and septic shock. Multilevel random effects modeling was employed whereby patients were nested within ZIP codes. Individual patient characteristics and socioeconomic variables aggregated at the ZIP code level (education, employment status, income, poverty level, access to healthcare) were included in the model. In hospital mortality, length of stay, need for vasopressors, and mechanical ventilation were the main endpoints. Black patients had more comorbidities than White patients except for cirrhosis and malignancy. In unadjusted comparisons, White individuals were more likely to require mechanical ventilation and had higher mortality rates and longer hospital stays for both low- and high-income groups. When nesting within ZIP codes and accounting for socioeconomic variables, race did not have a significant effect on mortality. Non-White races had lower odds ratio for mechanical ventilation. Our study demonstrates that race is not an independent risk factor for sepsis mortality, as well as sepsis-related length of stay. We should expand our inquiry into determinants of sepsis outcomes by including socioeconomic variables.