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Racial and Ethnic Disparities Persist in Outcomes After the 2015 Severe Sepsis and Septic Shock Early Management
Kalyan Chaliki1, Danny Hughes2, Frank LoVecchio2
1College of Medicine, The University of Arizona, Phoenix, Arizona.
Background:
Sepsis remains a significant public health concern, with evidence of significant racial and ethnic disparities in outcomes.
Objectives:
This study investigates how racial and ethnic disparities in severe sepsis and septic shock outcomes may have changed following the implementation of the 2015 Severe Sepsis and Septic Shock Early Management (SEP-1) Bundle.
Methods:
This was a retrospective analysis of a patient cohort from the 2013-2017 National Inpatient Sample datasets. ICD codes from the SEP-1 manual were used to identify eligible patients with severe sepsis or septic shock. Mortality rates, length of stay, and total costs were examined as primary outcomes using multivariable logistic and linear regression models, and an event study design was used to estimate changes in these outcomes post-SEP-1 implementation. Racial and ethnic disparities were assessed pre- and post-SEP-1 implementation, and differences in post-SEP-1 time trends in each outcome were compared across groups.
Results:
At baseline, racial and ethnic minorities, particularly Black patients, demonstrated significantly higher mortality rates, lengths of stay, and costs compared to White patients. Following SEP-1 implementation, there were overall reductions in mortality and costs; however, racial and ethnic disparities remained statistically unchanged. The event study analysis indicated a statistically significant decline in mortality rates post-SEP-1 bundle, and the benefits were experienced equally across all racial and ethnic groups.
Conclusions:
Despite the introduction of the SEP-1 guidelines leading to some improvements in severe sepsis and septic shock outcomes, racial and ethnic disparities in mortality, length of stay, and costs remained statistically significant.
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