Racial Disparities in Septic Shock Outcomes: A Nationwide Analysis (2016-2020).

BACKGROUND

The mortality rate and outcomes of septic shock can vary, depending on the patient's race. The most comprehensive national study on these racial disparities is dated, and recent studies have reported mixed findings.

OBJECTIVE

To gain insight into racial variation in outcomes of septic shock and understand underlying factors.

DESIGN

A retrospective analysis using National Inpatient Sample data (2016-2020). Patients were grouped by race, and patient and hospital characteristics, outcomes, and complications were compared. Multivariable logistic regression analyses were conducted.

PATIENTS

Hospitalized patients aged ≥ 18 years with septic shock.

MAIN MEASURES

In-hospital mortality, mechanical ventilation, vasopressor use, acute kidney injury, need for hemodialysis, acute myocardial infarction, requirement for blood transfusion, length of stay, the financial burden on healthcare, and resource utilization.

KEY RESULTS

Among 2,789,890 patients, 67.5% were White, 14.4% Black, 10.9% Hispanic, 3.3% Asian or Pacific Islander, and 0.8% Native American; 46.2% were aged > 70 years. Compared to White patients, Black patients had 23% higher odds of mortality (adjusted odds ratio [aOR] 1.23, 95% CI 1.21-1.25) and the highest odds of invasive mechanical ventilation (aOR 1.42) and hemodialysis (aOR 1.96). Native American patients had the highest odds of acute respiratory distress syndrome (aOR 2.03), while Asian or Pacific Islander patients had increased odds of blood transfusions (aOR 1.52). Palliative care consultations were less common among Asian, Black, and Hispanic patients compared to White patients.

CONCLUSIONS

Racial disparities persist in septic shock outcomes, with higher mortality and complications among Black, Hispanic, Asian, and Native American patients, along with less utilization of palliative care services compared to White patients.