Severe sepsis outcomes impacted by race, ethnicity, and insurance status

Previous research has offered information on the disparities in outcomes in sepsis in adults because of insurance status as well as race and ethnicity. However, there has been very little data on disparities in outcomes in children. A report in The Lancet Child & Adolescent Health looked at whether hospital outcomes for severe sepsis in children were affected by race, ethnicity, and insurance status.¹

The researchers ran a population-based, retrospective cohort study that used data from the 2016 database release from the Healthcare Cost and Utilization Project Kids’ Inpatient Database. The database included 3,117,413 hospital discharges, which covered 80% of discharges from 4200 hospitals in the United States across 47 states. They used multilevel logistic regression to look at the link between race, ethnicity, and insurance status with hospital mortality, adjusted for both individual-level and hospital-level characteristics.

A total of 12,297 children aged 0 to 21 years were admitted to 1253 hospitals for severe sepsis with or without shock in the data set. In this subset, 1265 were excluded because race/ethnicity were not recorded; 15 children did not have information on insurance status; and 1324 of the children were transferred from the hospital, which left a final subcohort of 9816 children. In this group, Black children were found to have higher odds of death than white children (adjusted odds ratio [OR] 1.19, 95 % CI 1.02–1.38; p=0.028). This increased odds of death was pushed by higher Black mortality in the south region (OR 1.30, 95% CI 1.04–1.62; p=0.019) and west region (OR 1. 58, 95% CI 1.05–2.38; p=0.027). Additionally, Hispanic children (adjusted hazard ratio [HR] 0.94, 95% CI 0.88–1.00; p=0.049) and Black children (HR 0.88, 95% CI 0.82–0.94; p=0.0002), in particular Black newborns (HR 0.53, 95% CI 0.36–0.77; p=0.0011) were found to have longer stays in the hospital. No survival difference was noted between children who were publicly and privately insured, but other insurance status, which included self-pay, no charge, or other, was tied to increased mortality (OR 1.30, 95% CI 1.04–1.61; p=0.021).

The researchers concluded that there were disparities in outcomes for severe sepsis because of race and ethnicity, along with insurance status. They urged further researcher into the causes behind the poorer outcomes found for both Black and Hispanic children.

Reference

1. Mitchell H, Reddy A, Montoya-Williams D, Harhay M, Fowler J, Yehya N. Hospital outcomes for children with severe sepsis in the USA by race or ethnicity and insurance status: a population-based, retrospective cohort study. Lancet Child Adolesc Health. 2021;5(2):103-112. doi:10.1016/s2352-4642(20)30341-2