PURPOSE: Severe sepsis is a leading cause of death and the most common diagnosis resulting in ICU admission. Severe sepsis occurs more frequently and has a higher risk of death in African-Americans (AA) than in whites, partially attributed to higher infection rates. South Carolina (SC) has substantial race-associated health disparities. We sought to determine: 1) whether there is regional variation in sepsis mortality within SC; and 2) to identify quality improvement opportunities by characterizing whether patients on chronic hemodialysis (HD) have race-associated variation in catheter infections and subsequent sepsis.
METHODS: Age-adjusted regional variation in sepsis mortality was characterized using 2010 SC population data. Subsequent analysis used Healthcare Cost and Utilization Project (HCUP) data from 2000-2005 to evaluate the frequency of catheter associated infections among SC patients on chronic HD. Regression analyses were performed, including covariates of age, race, co-morbidities (Charlson score), and years on HD.
RESULTS: SC has an overall age-adjusted sepsis mortality rate of 14-per-100,000 persons. As hypothesized, substantial in-state variation was found (Region A having a rate of 23-per-100,000; Region B having 11-per-100,000). HCUP data revealed of 5,107 persons on chronic HD, a majority were AA (63%, n=3168). Of 1290 catheter infections, a majority (65%, n=849; p= 0.05) occurred in AA. After controlling for age, co-morbidities, and years on HD, AA race remained an independent predictor of having a catheter infection (OR=1.18; 95%CI=1.03-1.35). We did not find higher rates of sepsis among AA patients on chronic HD.
CONCLUSIONS: SC Region A has a high proportion of individuals that are rural (49%), minority (41%), live below federal poverty levels (24%) and have a high prevalence of end-stage renal disease. We found a two-fold greater age-adjusted sepsis mortality rate in Region A and subsequently an association between catheter infections and African-American race among HD patients.
CLINICAL IMPLICATIONS: While this increased prevalence of catheter infections in this cohort did not translate into higher rates of sepsis among African-Americans, we identified significant opportunity for quality improvement to reduce catheter infections.
DISCLOSURE: The following authors have nothing to disclose: Lara Hiott, Kit Simpson, Jane Zapka, Dee Ford
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