Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO.
Division of Specialty Care Pharmacy, St. Louis College of Pharmacy, St. Louis, MO.
Crit Care Med. 2021 Mar 1;49(3):e258-e268. doi: 10.1097/CCM.0000000000004809.
To assess whether Black race is associated with a higher rate of all-cause readmission compared with White race following community-onset sepsis.
Retrospective cohort study.
One-thousand three-hundred bed urban academic medical centers.
Three-thousand three-hundred ninety patients hospitalized with community-onset sepsis between January 1, 2010, and December 31, 2017.
Community-onset sepsis was defined as patients admitted through the emergency department with an International Classification of Disease, ninth revision, Clinical Modification code for either severe sepsis (995.92) or septic shock (785.52). Beginning in 2015, we used International Classification of Disease, Tenth Revision, Clinical Modification codes R65.20 (severe sepsis) and R65.21 (septic shock). We excluded those individuals hospitalized at another acute care facility that were transferred to our facility. Race was abstracted electronically, and patients who expired or self-identified as a race other than Black or White race were excluded. Patients who experienced a subsequent hospitalization at our facility were considered to be readmitted.
Compared with White race, Black race demonstrated a significantly higher rate of all-cause readmission (60.8% vs 71.1%; p < 0.001), including a higher rate of readmission for sepsis (14.0% vs 19.8%; p < 0.001). Black patients also resided in zip codes with a lower median household income and were more likely to use public insurance compared with White race. Similar rates of comorbid diseases and disease burden were observed between the two groups, but vasopressors were less likely to be administered to Black patients. Multivariable analysis showed that Black race was associated with a 50% increased odds (odds ratio, 1.52, 99% CI, 1.25-1.84) in all-cause readmission risk compared with White race.
Black race was associated with a higher rate of all-cause and sepsis readmission, possibly as a result of unaddressed health disparities, compared with White race. Programs addressing healthcare disparities should use readmission as another marker of equity.
评估在社区获得性脓毒症后，与白种人相比，黑种人是否与更高的全因再入院率相关。
回顾性队列研究。
一家拥有 1300 张床位的城市学术医疗中心。
2010 年 1 月 1 日至 2017 年 12 月 31 日期间，因社区获得性脓毒症住院的 3390 名患者。
社区获得性脓毒症定义为通过急诊科入院的患者，其国际疾病分类，第九修订版，临床修正代码为严重脓毒症（995.92）或脓毒性休克（785.52）。从 2015 年开始，我们使用国际疾病分类，第十版，临床修正代码 R65.20（严重脓毒症）和 R65.21（脓毒性休克）。我们排除了在另一家急性护理机构住院并转至我们机构的患者。种族是通过电子方式提取的，并且死亡或自认为不属于黑种人或白种人的患者被排除在外。在我们机构再次住院的患者被视为再入院。
与白种人相比，黑种人全因再入院率（60.8%比 71.1%；p<0.001）显著更高，包括脓毒症再入院率（14.0%比 19.8%；p<0.001）更高。黑人患者的居住邮政编码中位数家庭收入也较低，并且与白种人相比，他们更有可能使用公共保险。两组之间观察到相似的合并症和疾病负担发生率，但血管加压药的使用可能性较小。多变量分析显示，与白种人相比，黑种人全因再入院风险增加 50%（优势比，1.52，99%置信区间，1.25-1.84）。
与白种人相比，黑种人全因和脓毒症再入院率更高，这可能是由于未解决的健康差异所致。解决医疗保健差异的计划应将再入院作为公平的另一个指标。
