Department of Internal Medicine, Division of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
Beth Israel Deaconess Medical Center, Boston, MA.
Crit Care Med. 2020 Jul;48(7):962-967. doi: 10.1097/CCM.0000000000004375.
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. 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 U.S. Census demographic information. A multivariate model employing a validated algorithm for mortality in sepsis using administrative data was used.
The National Inpatient Sample from 2008 to 2014.
Patients over 18 years of age with sepsis.
None.
A total of 4,221,221 patients with sepsis were identified. Of these, 612,217 patients (14.5%) were treated at hospitals disproportionately serving the black community (Black hospitals), whereas 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 nonminority hospital (odds ratio, 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 (odds ratio, 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 (nonminority hospitals: 5.9 d; interquartile range, 3.1-11.0 d vs Hispanic: 6.9 d; interquartile range, 3.6-12.9 d and Black: 6.7 d, interquartile range, 3.4-13.2 d; 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.
在各种疾病中，在少数民族服务比例过高的医院接受治疗与预后较差有关。我们在美国研究了在少数民族服务比例过高的医院接受治疗对脓毒症患者结局的影响。
回顾性队列分析。少数民族服务比例过高的医院定义为其少数民族患者比例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数据，确定了为黑人和西班牙裔患者服务的少数民族医院。采用多变量模型，使用经过验证的脓毒症死亡率算法对行政数据进行分析。
2008 年至 2014 年全国住院患者样本。
年龄在 18 岁以上的脓毒症患者。
无。
共确定了 4221221 例脓毒症患者。其中，612217 例（14.5%）患者在少数民族服务比例过高的医院（黑人医院）接受治疗，181141 例（4.3%）患者在少数民族服务比例过高的医院（西班牙裔医院）接受治疗。多变量分析后，与在非少数民族医院接受治疗相比，在黑人医院接受治疗与死亡率增加 4%相关（优势比，1.04；95%置信区间，1.03-1.05；p<0.01）。在西班牙裔医院接受治疗与死亡率增加 9%相关（优势比，1.09；95%置信区间，1.07-1.11；p<0.01）。在每个少数民族服务比例过高的医院，住院时间中位数延长近 1 天（非少数民族医院：5.9 d；四分位距，3.1-11.0 d；西班牙裔医院：6.9 d；四分位距，3.6-12.9 d；黑人医院：6.7 d；四分位距，3.4-13.2 d；均 p<0.01）。
无论种族如何，在少数民族服务比例过高的医院接受治疗的脓毒症患者的院内死亡率明显更高。
