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Galiatsatos P, Brems H, Myers CN, Montemayor K. Race, Ethnicity, and Gender Disparities in Management and Outcomes of Critically Ill Adults with Sepsis. Crit Care Clin 2024; 40:741-752. [PMID: 39218483 DOI: 10.1016/j.ccc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Critical care pathologies are not immune to potential social challenges in both health equity and health disparities. Over the last century, as sepsis physiology and interventions have continued to improve clinical outcomes, recognition that such improvements are not seen in all diverse populations warrants an understanding of this disproportionate success. In this review, the authors evaluate sepsis incidence and outcomes across ethnicity, race, and sex and gender, taking into account social and biological categorization and the association of sepsis-related mortality and morbidity. Further, the authors review how such issues transcend across age groups, with vulnerability to sepsis.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Health System, Baltimore, MD, USA.
| | - Henry Brems
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Carlie N Myers
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Kristina Montemayor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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2
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Stinehart KR, Hyer JM, Joshi S, Brummel NE. Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis. Crit Care Med 2024:00003246-990000000-00363. [PMID: 39137035 DOI: 10.1097/ccm.0000000000006397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures. DESIGN, SETTING, AND PATIENTS To test this hypothesis, we used data from 106,189 adult survivors of a sepsis hospitalization included in the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental database between 2013 and 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified hospitalizations for severe sepsis and septic shock using the International Classification of Diseases, 9th Edition (ICD-9) or 1CD-10 codes. We used Metropolitan Statistical Area classifications to categorize rurality. We measured emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits for the year following sepsis hospitalizations. We calculated the total expenditures for each of these categories. We compared outcomes between rural and urban patients using multivariable regression and adjusted for covariates. After adjusting for age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity, those living in rural areas had 17% greater odds of having an ED visit (odds ratio [OR] 1.17; 95% CI, 1.13-1.22; p < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87-0.94; p < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84-0.93; p < 0.001). Despite higher levels of ED use and equivalent levels of hospital readmissions, expenditures in these areas were 14% (OR 0.86; 95% CI, 0.80-0.91; p < 0.001) and 9% (OR 0.91; 95% CI, 0.87-0.96; p < 0.001) lower among rural survivors, respectively, suggesting these services may be used for lower-acuity conditions. CONCLUSIONS In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.
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Affiliation(s)
- Kyle R Stinehart
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
- Department of Internal Medicine, Center for Health Outcomes in Medicine Scholarship and Service (HOMES), The Ohio State University Wexner Medical Center, Columbus, OH
| | - J Madison Hyer
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH
- Secondary Data Core, The Ohio State University Center for Clinical and Translational Science, Columbus, OH
| | - Shivam Joshi
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH
- Secondary Data Core, The Ohio State University Center for Clinical and Translational Science, Columbus, OH
| | - Nathan E Brummel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
- Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University College of Medicine, Columbus, OH
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University College of Medicine, Columbus, OH
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3
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van Staa TP, Pate A, Martin GP, Sharma A, Dark P, Felton T, Zhong X, Bladon S, Cunningham N, Gilham EL, Brown CS, Mirfenderesky M, Palin V, Ashiru-Oredope D. Sepsis and case fatality rates and associations with deprivation, ethnicity, and clinical characteristics: population-based case-control study with linked primary care and hospital data in England. Infection 2024; 52:1469-1479. [PMID: 38627354 PMCID: PMC11288984 DOI: 10.1007/s15010-024-02235-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/12/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. The purpose of the study was to measure the associations of specific exposures (deprivation, ethnicity, and clinical characteristics) with incident sepsis and case fatality. METHODS Two research databases in England were used including anonymized patient-level records from primary care linked to hospital admission, death certificate, and small-area deprivation. Sepsis cases aged 65-100 years were matched to up to six controls. Predictors for sepsis (including 60 clinical conditions) were evaluated using logistic and random forest models; case fatality rates were analyzed using logistic models. RESULTS 108,317 community-acquired sepsis cases were analyzed. Severe frailty was strongly associated with the risk of developing sepsis (crude odds ratio [OR] 14.93; 95% confidence interval [CI] 14.37-15.52). The quintile with most deprived patients showed an increased sepsis risk (crude OR 1.48; 95% CI 1.45-1.51) compared to least deprived quintile. Strong predictors for sepsis included antibiotic exposure in prior 2 months, being house bound, having cancer, learning disability, and diabetes mellitus. Severely frail patients had a case fatality rate of 42.0% compared to 24.0% in non-frail patients (adjusted OR 1.53; 95% CI 1.41-1.65). Sepsis cases with recent prior antibiotic exposure died less frequently compared to non-users (adjusted OR 0.7; 95% CI 0.72-0.76). Case fatality strongly decreased over calendar time. CONCLUSION Given the variety of predictors and their level of associations for developing sepsis, there is a need for prediction models for risk of developing sepsis that can help to target preventative antibiotic therapy.
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Affiliation(s)
- Tjeerd Pieter van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Vaughan House, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Alexander Pate
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Vaughan House, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Glen P Martin
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Vaughan House, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Anita Sharma
- Chadderton South Health Centre, Eaves Lane, Chadderton, Oldham, OL9 8RG, UK
| | - Paul Dark
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tim Felton
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Intensive Care Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Xiaomin Zhong
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Vaughan House, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Sian Bladon
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Vaughan House, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Neil Cunningham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, SW1P 3JR, UK
| | - Ellie L Gilham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, SW1P 3JR, UK
| | - Colin S Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, SW1P 3JR, UK
- NIHR Health Protection Unit in Healthcare-Associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
| | - Mariyam Mirfenderesky
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, SW1P 3JR, UK
| | - Victoria Palin
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Vaughan House, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, The University of Manchester, Manchester, M13 9WL, UK
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, SW1P 3JR, UK
- School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
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La Via L, Sangiorgio G, Stefani S, Marino A, Nunnari G, Cocuzza S, La Mantia I, Cacopardo B, Stracquadanio S, Spampinato S, Lavalle S, Maniaci A. The Global Burden of Sepsis and Septic Shock. EPIDEMIOLOGIA 2024; 5:456-478. [PMID: 39189251 PMCID: PMC11348270 DOI: 10.3390/epidemiologia5030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/07/2024] [Accepted: 07/18/2024] [Indexed: 08/28/2024] Open
Abstract
A dysregulated host response to infection causes organ dysfunction in sepsis and septic shock, two potentially fatal diseases. They continue to be major worldwide health burdens with high rates of morbidity and mortality despite advancements in medical care. The goal of this thorough review was to present a thorough summary of the current body of knowledge about the prevalence of sepsis and septic shock worldwide. Using widely used computerized databases, a comprehensive search of the literature was carried out, and relevant studies were chosen in accordance with predetermined inclusion and exclusion criteria. A narrative technique was used to synthesize the data that were retrieved. The review's conclusions show how widely different locations and nations differ in terms of sepsis and septic shock's incidence, prevalence, and fatality rates. Compared to high-income countries (HICs), low- and middle-income countries (LMICs) are disproportionately burdened more heavily. We talk about risk factors, comorbidities, and difficulties in clinical management and diagnosis in a range of healthcare settings. The review highlights the need for more research, enhanced awareness, and context-specific interventions in order to successfully address the global burden of sepsis and septic shock.
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Affiliation(s)
- Luigi La Via
- Department of Anaesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 24046 Catania, Italy
| | - Giuseppe Sangiorgio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (G.S.); (S.S.); (S.S.)
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (G.S.); (S.S.); (S.S.)
| | - Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.N.); (B.C.); (S.S.)
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.N.); (B.C.); (S.S.)
| | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (S.C.); (I.L.M.)
| | - Ignazio La Mantia
- Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (S.C.); (I.L.M.)
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.N.); (B.C.); (S.S.)
| | - Stefano Stracquadanio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy; (G.S.); (S.S.); (S.S.)
| | - Serena Spampinato
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (G.N.); (B.C.); (S.S.)
| | - Salvatore Lavalle
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (S.L.); (A.M.)
| | - Antonino Maniaci
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (S.L.); (A.M.)
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5
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Sheikh F, Douglas W, Diao YD, Correia RH, Gregoris R, Machon C, Johnston N, Fox-Robichaud AE. Social determinants of health and sepsis: a case-control study. Can J Anaesth 2024:10.1007/s12630-024-02790-6. [PMID: 38955983 DOI: 10.1007/s12630-024-02790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/17/2024] [Accepted: 04/04/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE We aimed to identify whether social determinants of health (SDoH) are associated with the development of sepsis and assess the differences between individuals living within systematically disadvantaged neighbourhoods compared with those living outside these neighbourhoods. METHODS We conducted a single-centre case-control study including 300 randomly selected adult patients (100 patients with sepsis and 200 patients without sepsis) admitted to the emergency department of a large academic tertiary care hospital in Hamilton, ON, Canada. We collected data on demographics and a limited set of SDoH variables, including neighbourhood household income, smoking history, social support, and history of alcohol disorder. We analyzed study data using multivariate logistic regression models. RESULTS The study included 100 patients with sepsis with a median [interquartile range (IQR)] age of 75 [58-84] yr and 200 patients without sepsis with a median [IQR] age of 72 [60-83] yr. Factors significantly associated with sepsis included arrival by ambulance, absence of a family physician, higher Hamilton Early Warning Score, and a recorded history of dyslipidemia. Important SDoH variables, such as individual or household income and race, were not available in the medical chart. In patients with SDoH available in their medical records, no SDoH was significantly associated with sepsis. Nevertheless, compared with their proportion of the Hamilton population, the rate of sepsis cases and sepsis deaths was approximately two times higher among patients living in systematically disadvantaged neighbourhoods. CONCLUSIONS This study revealed the lack of available SDoH data in electronic health records. Despite no association between the SDoH variables available and sepsis, we found a higher rate of sepsis cases and sepsis deaths among individuals living in systematically disadvantaged neighbourhoods. Including SDoH in electronic health records is crucial to study their effect on the risk of sepsis and to provide equitable care.
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Affiliation(s)
- Fatima Sheikh
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Hamilton Health Sciences, Hamilton, ON, Canada.
- David Braley Research Institute (DBRI), C5-1B, 20 Copeland Ave., Hamilton, ON, L8L 2X2, Canada.
| | - William Douglas
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Yi David Diao
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Rebecca H Correia
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Rachel Gregoris
- Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Christina Machon
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Neil Johnston
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alison E Fox-Robichaud
- Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Oud L, Garza J. Trajectories of State-Level Sepsis-Related Mortality by Race and Ethnicity Group in the United States. J Clin Med 2024; 13:2848. [PMID: 38792390 PMCID: PMC11122657 DOI: 10.3390/jcm13102848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Recent reports on the national temporal trends of sepsis-related mortality in the United States (US) suggested improvement of outcomes in several race and ethnicity groups. However, it is unknown whether national data reflect state-level trajectories. Methods: We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death data set to identify all decedents with sepsis in the US during 2010-2019. Negative binomial regression models were fit to estimate national and state-level trends of age-adjusted sepsis-related mortality rates within race and ethnicity groups. Results: There were 1,852,610 sepsis-related deaths in the US during 2010-2019. Nationally, sepsis-related mortality rates decreased among Blacks and Asians, were unchanged among Hispanics and Native Americans, and rose among Whites. The percent of states with similar trends were 30.0% among Blacks, 32.1% among Asians, 74.3% among Hispanics, 75.0% among Native Americans, and 66.7%% among Whites, while trending in opposite direction from 3.6% among Asians to 15.0% among Blacks. Conclusions: National trends in sepsis-related mortality in the US did not represent state-level trajectories in race ethnicity groups. Gains in sepsis outcomes among race and ethnicity groups at the national level were not shared equitably at the state level.
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Affiliation(s)
- Lavi Oud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX 79763, USA
| | - John Garza
- Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th Street, Odessa, TX 79763, USA;
- Department of Mathematics, The University of Texas of the Permian Basin, 4901 E. University Blvd, Odessa, TX 79762, USA
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Andrist E, Clarke RG, Phelps KB, Dews AL, Rodenbough A, Rose JA, Zurca AD, Lawal N, Maratta C, Slain KN. Understanding Disparities in the Pediatric ICU: A Scoping Review. Pediatrics 2024; 153:e2023063415. [PMID: 38639640 DOI: 10.1542/peds.2023-063415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health disparities are pervasive in pediatrics. We aimed to describe disparities among patients who are likely to be cared for in the PICU and delineate how sociodemographic data are collected and categorized. METHODS Using MEDLINE as a data source, we identified studies which included an objective to assess sociodemographic disparities among PICU patients in the United States. We created a review rubric, which included methods of sociodemographic data collection and analysis, outcome and exposure variables assessed, and study findings. Two authors reviewed every study. We used the National Institute on Minority Health and Health Disparities Research Framework to organize outcome and exposure variables. RESULTS The 136 studies included used variable methods of sociodemographic data collection and analysis. A total of 30 of 124 studies (24%) assessing racial disparities used self- or parent-identified race. More than half of the studies (52%) dichotomized race as white and "nonwhite" or "other" in some analyses. Socioeconomic status (SES) indicators also varied; only insurance status was used in a majority of studies (72%) evaluating SES. Consistent, although not uniform, disadvantages existed for racial minority populations and patients with indicators of lower SES. The authors of only 1 study evaluated an intervention intended to mitigate health disparities. Requiring a stated objective to evaluate disparities aimed to increase the methodologic rigor of included studies but excluded some available literature. CONCLUSIONS Variable, flawed methodologies diminish our understanding of disparities in the PICU. Meaningfully understanding and addressing health inequity requires refining how we collect, analyze, and interpret relevant data.
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Affiliation(s)
- Erica Andrist
- Division of Pediatric Critical Care Medicine
- Departments of Pediatrics
| | - Rachel G Clarke
- Division of Pediatric Critical Care Medicine, Upstate University Hospital, Syracuse, New York
- Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York
| | - Kayla B Phelps
- Division of Pediatric Critical Care Medicine, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Alyssa L Dews
- Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan
- Susan B. Meister Child Health and Adolescent Research Center, University of Michigan, Ann Arbor, Michigan
| | - Anna Rodenbough
- Division of Pediatric Critical Care Medicine, Children's Hospital of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jerri A Rose
- Pediatric Emergency Medicine
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Adrian D Zurca
- Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nurah Lawal
- Stepping Stones Pediatric Palliative Care Program, C.S. Mott Children's Hospital, Ann Arbor, Michigan
- Departments of Pediatrics
| | - Christina Maratta
- Department of Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katherine N Slain
- Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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8
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Bladon S, Ashiru-Oredope D, Cunningham N, Pate A, Martin GP, Zhong X, Gilham EL, Brown CS, Mirfenderesky M, Palin V, van Staa TP. Rapid systematic review on risks and outcomes of sepsis: the influence of risk factors associated with health inequalities. Int J Equity Health 2024; 23:34. [PMID: 38383380 PMCID: PMC10882893 DOI: 10.1186/s12939-024-02114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND AIMS Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around recognition and antibiotic treatment of sepsis, but did not consider factors relating to health inequalities. The aim of this study was to summarise the literature investigating associations between health inequalities and sepsis. METHODS Searches were conducted in Embase for peer-reviewed articles published since 2010 that included sepsis in combination with one of the following five areas: socioeconomic status, race/ethnicity, community factors, medical needs and pregnancy/maternity. RESULTS Five searches identified 1,402 studies, with 50 unique studies included in the review after screening (13 sociodemographic, 14 race/ethnicity, 3 community, 3 care/medical needs and 20 pregnancy/maternity; 3 papers examined multiple health inequalities). Most of the studies were conducted in the USA (31/50), with only four studies using UK data (all pregnancy related). Socioeconomic factors associated with increased sepsis incidence included lower socioeconomic status, unemployment and lower education level, although findings were not consistent across studies. For ethnicity, mixed results were reported. Living in a medically underserved area or being resident in a nursing home increased risk of sepsis. Mortality rates after sepsis were found to be higher in people living in rural areas or in those discharged to skilled nursing facilities while associations with ethnicity were mixed. Complications during delivery, caesarean-section delivery, increased deprivation and black and other ethnic minority race were associated with post-partum sepsis. CONCLUSION There are clear correlations between sepsis morbidity and mortality and the presence of factors associated with health inequalities. To inform local guidance and drive public health measures, there is a need for studies conducted across more diverse setting and countries.
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Affiliation(s)
- Siân Bladon
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
- School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Neil Cunningham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Alexander Pate
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Glen P Martin
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Xiaomin Zhong
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Ellie L Gilham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Colin S Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
- NIHR Health Protection Unit in Healthcare-Associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
| | - Mariyam Mirfenderesky
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Victoria Palin
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, The University of Manchester, Manchester, M13 9WL, UK
| | - Tjeerd P van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
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Varagur K, Murphy J, Skolnick GB, Naidoo SD, Grames LM, Dunsky KA, Menezes M, Snyder-Warwick AK, Patel KB. Impact of Neighborhood Deprivation and Social Vulnerability on Outcomes and Interventions in Patients with Cleft Palate. Cleft Palate Craniofac J 2024:10556656231226070. [PMID: 38196266 DOI: 10.1177/10556656231226070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE To examine whether neighborhood disadvantage impacts length of follow-up, interventions, and outcomes for patients with cleft palate. DESIGN Retrospective cohort. SETTING Cleft Palate Craniofacial Institute Database at St. Louis Children's Hospital. PATIENTS/PARTICIPANTS Patients with cleft palate following in St. Louis Children's Hospital Cleft Palate Multidisciplinary Team Clinic. INTERVENTIONS Primary palatoplasty between 2012-2017. Patients were divided into quartiles across area deprivation index (ADI) and social vulnerability index (SVI), two validated, composite metrics of neighborhood disadvantage, to examine whether living in neighborhoods from different deprivation quartiles impacts outcomes of interest. MAIN OUTCOME MEASURE Follow-up through age 5, surgeries and surgical complications, speech, developmental, and behavioral outcomes. RESULTS 205 patients were included. 39% of patients belonged to the most deprived ADI quartile, while 15% belonged to the most vulnerable SVI quartile. There were no differences between ADI or SVI quartiles in number of operations received (p ≥ 0.40). Patients in the most deprived ADI quartile were significantly more likely to have speech/language concerns (OR 2.32, 95% CI [1.20-4.89], p = 0.01). Being in a more vulnerable SVI quartile was associated with developmental delay (OR 2.29, 95% CI [1.04-5.15], p = 0.04). ADI and SVI quartile did not impact risk of loss to follow-up in the isolated and combined cleft lip and palate subgroups (p ≥ 0.21). CONCLUSIONS Neighborhood disadvantage impacts speech and developmental outcomes in patients with cleft palate despite comparable length of follow-up in multidisciplinary team clinic.
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Affiliation(s)
- Kaamya Varagur
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - John Murphy
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Lynn M Grames
- The Cleft Palate-Craniofacial Institute, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Katherine A Dunsky
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO, USA
| | - Maithilee Menezes
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO, USA
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
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10
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Zhong X, Ashiru-Oredope D, Pate A, Martin GP, Sharma A, Dark P, Felton T, Lake C, MacKenna B, Mehrkar A, Bacon SC, Massey J, Inglesby P, Goldacre B, Hand K, Bladon S, Cunningham N, Gilham E, Brown CS, Mirfenderesky M, Palin V, van Staa TP. Clinical and health inequality risk factors for non-COVID-related sepsis during the global COVID-19 pandemic: a national case-control and cohort study. EClinicalMedicine 2023; 66:102321. [PMID: 38192590 PMCID: PMC10772239 DOI: 10.1016/j.eclinm.2023.102321] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 01/10/2024] Open
Abstract
Background Sepsis, characterised by significant morbidity and mortality, is intricately linked to socioeconomic disparities and pre-admission clinical histories. This study aspires to elucidate the association between non-COVID-19 related sepsis and health inequality risk factors amidst the pandemic in England, with a secondary focus on their association with 30-day sepsis mortality. Methods With the approval of NHS England, we harnessed the OpenSAFELY platform to execute a cohort study and a 1:6 matched case-control study. A sepsis diagnosis was identified from the incident hospital admissions record using ICD-10 codes. This encompassed 248,767 cases with non-COVID-19 sepsis from a cohort of 22.0 million individuals spanning January 1, 2019, to June 31, 2022. Socioeconomic deprivation was gauged using the Index of Multiple Deprivation score, reflecting indicators like income, employment, and education. Hospitalisation-related sepsis diagnoses were categorised as community-acquired or hospital-acquired. Cases were matched to controls who had no recorded diagnosis of sepsis, based on age (stepwise), sex, and calendar month. The eligibility criteria for controls were established primarily on the absence of a recorded sepsis diagnosis. Associations between potential predictors and odds of developing non-COVID-19 sepsis underwent assessment through conditional logistic regression models, with multivariable regression determining odds ratios (ORs) for 30-day mortality. Findings The study included 224,361 (10.2%) cases with non-COVID-19 sepsis and 1,346,166 matched controls. The most socioeconomic deprived quintile was associated with higher odds of developing non-COVID-19 sepsis than the least deprived quintile (crude OR 1.80 [95% CI 1.77-1.83]). Other risk factors (after adjusting comorbidities) such as learning disability (adjusted OR 3.53 [3.35-3.73]), chronic liver disease (adjusted OR 3.08 [2.97-3.19]), chronic kidney disease (stage 4: adjusted OR 2.62 [2.55-2.70], stage 5: adjusted OR 6.23 [5.81-6.69]), cancer, neurological disease, immunosuppressive conditions were also associated with developing non-COVID-19 sepsis. The incidence rate of non-COVID-19 sepsis decreased during the COVID-19 pandemic and rebounded to pre-pandemic levels (April 2021) after national lockdowns had been lifted. The 30-day mortality risk in cases with non-COVID-19 sepsis was higher for the most deprived quintile across all periods. Interpretation Socioeconomic deprivation, comorbidity and learning disabilities were associated with an increased odds of developing non-COVID-19 related sepsis and 30-day mortality in England. This study highlights the need to improve the prevention of sepsis, including more precise targeting of antimicrobials to higher-risk patients. Funding The UK Health Security Agency, Health Data Research UK, and National Institute for Health Research.
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Affiliation(s)
- Xiaomin Zhong
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - Alexander Pate
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
| | - Glen P. Martin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
| | - Anita Sharma
- Chadderton South Health Centre, Eaves Lane, Chadderton, Oldham OL9 8RG, UK
| | - Paul Dark
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tim Felton
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Intensive Care Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Claire Lake
- Maples Medical Centre, 2 Scout Dr, Baguley, Manchester M23 2SY, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
- NHS England, Wellington House, Waterloo Road, London SE1 8UG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Sebastian C.J. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Kieran Hand
- Pharmacy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sian Bladon
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
| | - Neil Cunningham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
| | - Ellie Gilham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
| | - Colin S. Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
- NIHR Health Protection Unit in Healthcare-Associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
| | - Mariyam Mirfenderesky
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
- Division of Developmental Biology and Medicine, Maternal and Fetal Research Centre, The University of Manchester, St Marys Hospital, Oxford Road, Manchester M13 9WL, UK
| | - Tjeerd Pieter van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
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11
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Kapp KL, Ji Choi M, Bai K, Du L, Yende S, Kellum JA, Angus DC, Peck-Palmer OM, Robinson RAS. PATHWAYS ASSOCIATED WITH POSITIVE SEPSIS SURVIVAL OUTCOMES IN AFRICAN AMERICAN/BLACK AND NON-HISPANIC WHITE PATIENTS WITH URINARY TRACT INFECTION. Shock 2023; 60:362-372. [PMID: 37493584 PMCID: PMC10527228 DOI: 10.1097/shk.0000000000002176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
ABSTRACT Urinary tract infections (UTIs) are a common cause of sepsis worldwide. Annually, more than 60,000 US deaths can be attributed to sepsis secondary to UTIs, and African American/Black adults have higher incidence and case-fatality rates than non-Hispanic White adults. Molecular-level factors that may help partially explain differences in sepsis survival outcomes between African American/Black and Non-Hispanic White adults are not clear. In this study, patient samples (N = 166) from the Protocolized Care for Early Septic Shock cohort were analyzed using discovery-based plasma proteomics. Patients had sepsis secondary to UTIs and were stratified according to self-identified racial background and sepsis survival outcomes. Proteomics results suggest patient heterogeneity across mechanisms driving survival from sepsis secondary to UTIs. Differentially expressed proteins (n = 122, false discovery rate-adjusted P < 0.05) in Non-Hispanic White sepsis survivors were primarily in immune system pathways, while differentially expressed proteins (n = 47, false discovery rate-adjusted P < 0.05) in African American/Black patients were mostly in metabolic pathways. However, in all patients, regardless of racial background, there were 16 differentially expressed proteins in sepsis survivors involved in translation initiation and shutdown pathways. These pathways are potential targets for prognostic intervention. Overall, this study provides information about molecular factors that may help explain disparities in sepsis survival outcomes among African American/Black and Non-Hispanic White patients with primary UTIs.
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Affiliation(s)
- Kathryn L. Kapp
- Department of Chemistry, Vanderbilt University, Nashville, TN, 37235, USA
- The Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, 32732, USA
| | - Min Ji Choi
- Department of Chemistry, Vanderbilt University, Nashville, TN, 37235, USA
| | - Kun Bai
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
- Vanderbilt Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Sachin Yende
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA
| | - John A. Kellum
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Derek C. Angus
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA
| | - Octavia M. Peck-Palmer
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Renã A. S. Robinson
- Department of Chemistry, Vanderbilt University, Nashville, TN, 37235, USA
- The Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, 32732, USA
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12
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Kapur S, Sakyi KS, Lohia P, Goble DJ. Potential Factors Associated with Healthcare Utilization for Balance Problems in Community-Dwelling Adults within the United States: A Narrative Review. Healthcare (Basel) 2023; 11:2398. [PMID: 37685432 PMCID: PMC10486920 DOI: 10.3390/healthcare11172398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Falls are the leading cause of mortality and chronic disability in elderly adults. There are effective fall prevention interventions available. But only a fraction of the individuals with balance/dizziness problems are seeking timely help from the healthcare system. Current literature confirms the underutilization of healthcare services for the management of balance problems in adults, especially older adults. This review article explores factors associated with healthcare utilization as guided by the Andersen Healthcare Utilization Model, a framework frequently used to explore the factors leading to the use of health services. Age, sex, race/ethnicity, BMI, and comorbidities have been identified as some of the potential predisposing factors; socioeconomic status, health insurance, and access to primary care are the enabling and disabling factors; and severity of balance problem, perceived illness, and its impact on daily activities are the factors affecting need for care associated with healthcare utilization for balance or dizziness problems. Knowledge about these barriers can help direct efforts towards improved screening of vulnerable individuals, better access to care, and education regarding effective fall prevention interventions for those who are at risk for underutilization. This can aid in timely identification and management of balance problems, thereby reducing the incidence of falls.
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Affiliation(s)
- Shweta Kapur
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (S.K.); (K.S.S.); (D.J.G.)
| | - Kwame S. Sakyi
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (S.K.); (K.S.S.); (D.J.G.)
| | - Prateek Lohia
- Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Daniel J. Goble
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (S.K.); (K.S.S.); (D.J.G.)
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13
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Lusk JB, Blass B, Mahoney H, Hoffman MN, Clark AG, Bae J, Ashana DC, Cox CE, Hammill BG. Neighborhood socioeconomic deprivation, healthcare access, and 30-day mortality and readmission after sepsis or critical illness: findings from a nationwide study. Crit Care 2023; 27:287. [PMID: 37454127 PMCID: PMC10349422 DOI: 10.1186/s13054-023-04565-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND To determine if neighborhood socioeconomic deprivation independently predicts 30-day mortality and readmission for patients with sepsis or critical illness after adjusting for individual poverty, demographics, comorbidity burden, access to healthcare, and characteristics of treating healthcare facilities. METHODS We performed a nationwide study of United States Medicare beneficiaries from 2017 to 2019. We identified hospitalized patients with severe sepsis and patients requiring prolonged mechanical ventilation, tracheostomy, or extracorporeal membrane oxygenation (ECMO) through Diagnosis Related Groups (DRGs). We estimated the association between neighborhood socioeconomic deprivation, measured by the Area Deprivation Index (ADI), and 30-day mortality and unplanned readmission using logistic regression models with restricted cubic splines. We sequentially adjusted for demographics, individual poverty, and medical comorbidities, access to healthcare services; and characteristics of treating healthcare facilities. RESULTS A total of 1,526,405 admissions were included in the mortality analysis and 1,354,548 were included in the readmission analysis. After full adjustment, 30-day mortality for patients was higher for those from most-deprived neighborhoods (ADI 100) compared to least deprived neighborhoods (ADI 1) for patients with severe sepsis (OR 1.35 95% [CI 1.29-1.42]) or with prolonged mechanical ventilation with or without sepsis (OR 1.42 [95% CI 1.31, 1.54]). This association was linear and dose dependent. However, neighborhood socioeconomic deprivation was not associated with 30-day unplanned readmission for patients with severe sepsis and was inversely associated with readmission for patients requiring prolonged mechanical ventilation with or without sepsis. CONCLUSIONS A strong association between neighborhood socioeconomic deprivation and 30-day mortality for critically ill patients is not explained by differences in individual poverty, demographics, measured baseline medical risk, access to healthcare resources, or characteristics of treating hospitals.
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Affiliation(s)
- Jay B Lusk
- Duke University School of Medicine, Durham, NC, USA
- Duke University Fuqua School of Business, Durham, NC, USA
| | - Beau Blass
- Duke University School of Medicine, Durham, NC, USA
| | - Hannah Mahoney
- Duke University Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA
| | - Molly N Hoffman
- Duke University Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA
| | - Amy G Clark
- Duke University Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA
| | - Jonathan Bae
- Duke University Health System, Durham, NC, USA
- Duke University Department of Medicine, Durham, NC, USA
| | | | | | - Bradley G Hammill
- Duke University School of Medicine, Durham, NC, USA.
- Duke University Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA.
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14
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Matthaeus-Kraemer CT, Rose N, Spoden M, Pletz MW, Reinhart K, Fleischmann-Struzek C. Urban-Rural Disparities in Case Fatality of Community-Acquired Sepsis in Germany: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105867. [PMID: 37239593 DOI: 10.3390/ijerph20105867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND We aimed to examine urban-rural disparities in sepsis case fatality rates among patients with community-acquired sepsis in Germany. METHODS Retrospective cohort study using de-identified data of the nationwide statutory health insurance AOK, covering approx. 30% of the German population. We compared in-hospital- and 12-month case fatality between rural and urban sepsis patients. We calculated odds ratios (OR) with 95% confidence intervals and the estimated adjusted odds ratio (ORadj) using logistic regression models to account for potential differences in the distribution of age, comorbidities, and sepsis characteristics between rural and urban citizens. RESULTS We identified 118,893 hospitalized patients with community-acquired sepsis in 2013-2014 with direct hospital admittance. Sepsis patients from rural areas had lower in-hospital case fatality rates compared to their urban counterparts (23.7% vs. 25.5%, p < 0.001, Odds Ratio (OR) = 0.91 (95% CI 0.88, 0.94), ORadj = 0.89 (95% CI 0.86, 0.92)). Similar differences were observable for 12-month case fatalities (45.8% rural vs. 47.0% urban 12-month case fatality, p < 0.001, OR = 0.95 (95% CI 0.93, 0.98), ORadj = 0.92 (95% CI 0.89, 0.94)). Survival benefits were also observable in rural patients with severe community-acquired sepsis or patients admitted as emergencies. Rural patients of <40 years had half the odds of dying in hospital compared to urban patients in this age bracket (ORadj = 0.49 (95% CI 0.23, 0.75), p = 0.002). CONCLUSION Rural residence is associated with short- and long-term survival benefits in patients with community-acquired sepsis. Further research on patient, community, and health-care system factors is needed to understand the causative mechanisms of these disparities.
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Affiliation(s)
- Claudia T Matthaeus-Kraemer
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany
| | - Norman Rose
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany
| | - Melissa Spoden
- Wissenschaftliches Institut der Ortskrankenkassen, 10178 Berlin, Germany
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Operative Intensive Care, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Carolin Fleischmann-Struzek
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany
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15
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Ahlberg CD, Wallam S, Tirba LA, Itumba SN, Gorman L, Galiatsatos P. Linking Sepsis with chronic arterial hypertension, diabetes mellitus, and socioeconomic factors in the United States: A scoping review. J Crit Care 2023; 77:154324. [PMID: 37159971 DOI: 10.1016/j.jcrc.2023.154324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/11/2023]
Abstract
RATIONALE Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host immune response to infection. Social risk factors including location and poverty are associated with sepsis-related disparities. Understanding the social and biological phenotypes linked with the incidence of sepsis is warranted to identify the most at-risk populations. We aim to examine how factors in disadvantage influence health disparities related to sepsis. METHODS A scoping review was performed for English-language articles published in the United States from 1990 to 2022 on PubMed, Web of Science, and Scopus. Of the 2064 articles found, 139 met eligibility criteria and were included for review. RESULTS There is consistency across the literature of disproportionately higher rates of sepsis incidence, mortality, readmissions, and associated complications, in neighborhoods with socioeconomic disadvantage and significant poverty. Chronic arterial hypertension and diabetes mellitus also occur more frequently in the same geographic distribution as sepsis, suggesting a potential shared pathophysiology. CONCLUSIONS The distribution of chronic arterial hypertension, diabetes mellitus, social risk factors associated with socioeconomic disadvantage, and sepsis incidence, are clustered in specific geographical areas and linked by endothelial dysfunction. Such population factors can be utilized to create equitable interventions aimed at mitigating sepsis incidence and sepsis-related disparities.
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Affiliation(s)
- Caitlyn D Ahlberg
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Sara Wallam
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Lemya A Tirba
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Stephanie N Itumba
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Linda Gorman
- Harrison Medical Library, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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16
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Stensrud VH, Gustad LT, Damås JK, Solligård E, Krokstad S, Nilsen TIL. Direct and indirect effects of socioeconomic status on sepsis risk and mortality: a mediation analysis of the HUNT Study. J Epidemiol Community Health 2023; 77:168-174. [PMID: 36707239 DOI: 10.1136/jech-2022-219825] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Socioeconomic status (SES) may influence risk of sepsis and sepsis-related mortality, but to what extent lifestyle and health-related factors mediate this effect is not known. METHODS The study included 65 227 participants of the population-based HUNT Study in Norway linked with hospital records to identify incident sepsis and sepsis-related deaths. Cox regression estimated HRs of sepsis risk and mortality associated with different indicators of SES, whereas mediation analyses were based on an inverse odds weighting approach. RESULTS During ~23 years of follow-up (1.3 million person-years), 4200 sepsis cases and 1277 sepsis-related deaths occurred. Overall, participants with low SES had a consistently increased sepsis risk and sepsis-related mortality using education, occupational class and financial difficulties as indicators of SES. Smoking and alcohol consumption explained 57% of the sepsis risk related to low education, whereas adding risk factors of cardiovascular disease and chronic diseases to the model increased the explained proportion to 78% and 82%, respectively. CONCLUSION This study shows that SES is inversely associated with sepsis risk and mortality. Approximately 80% of the effect of education on sepsis risk was explained by modifiable lifestyle and health-related factors that could be targets for prevention.
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Affiliation(s)
- Vilde Hatlevoll Stensrud
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway .,Deptartment of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lise Tuset Gustad
- Deptartment of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University - Levanger Campus, Levanger, Norway.,Department of Medicine and Rehabilitation, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
| | - Jan Kristian Damås
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Infectious Diseases, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Erik Solligård
- Deptartment of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research and Development, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway.,Department of Mental Health Care and Substance Abuse, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
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17
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Mercurio L, Pou S, Duffy S, Eickhoff C. Risk Factors for Pediatric Sepsis in the Emergency Department: A Machine Learning Pilot Study. Pediatr Emerg Care 2023; 39:e48-e56. [PMID: 36648121 DOI: 10.1097/pec.0000000000002893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify underappreciated sepsis risk factors among children presenting to a pediatric emergency department (ED). METHODS A retrospective observational study (2017-2019) of children aged 18 years and younger presenting to a pediatric ED at a tertiary care children's hospital with fever, hypotension, or an infectious disease International Classification of Diseases (ICD)-10 diagnosis. Structured patient data including demographics, problem list, and vital signs were extracted for 35,074 qualifying ED encounters. According to the Improving Pediatric Sepsis Outcomes Classification, confirmed by expert review, 191 patients met clinical sepsis criteria. Five machine learning models were trained to predict sepsis/nonsepsis outcomes. Top features enabling model performance (N = 20) were then extracted to identify patient risk factors. RESULTS Machine learning methods reached a performance of up to 93% sensitivity and 84% specificity in identifying patients who received a hospital diagnosis of sepsis. A random forest classifier performed the best, followed by a classification and regression tree. Maximum documented heart rate was the top feature in these models, with importance coefficients (ICs) of 0.09 and 0.21, which represent how much an individual feature contributes to the model. Maximum mean arterial pressure was the second most important feature (IC 0.05, 0.13). Immunization status (IC 0.02), age (IC 0.03), and patient zip code (IC 0.02) were also among the top features enabling models to predict sepsis from ED visit data. Stratified analysis revealed changes in the predictive importance of risk factors by race, ethnicity, oncologic history, and insurance status. CONCLUSIONS Machine learning models trained to identify pediatric sepsis using ED clinical and sociodemographic variables confirmed well-established predictors, including heart rate and mean arterial pressure, and identified underappreciated relationships between sepsis and patient age, immunization status, and demographics.
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Affiliation(s)
- Laura Mercurio
- From the Section of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Sovijja Pou
- Alpert Medical School of Brown University, Providence, RI
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18
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Kapp KL, Arul AB, Zhang KC, Du L, Yende S, Kellum JA, Angus DC, Peck-Palmer OM, Robinson RAS. Proteomic changes associated with racial background and sepsis survival outcomes. Mol Omics 2022; 18:923-937. [PMID: 36097965 DOI: 10.1039/d2mo00171c] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Intra-abdominal infection is a common cause of sepsis, and intra-abdominal sepsis leads to ∼156 000 U.S. deaths annually. African American/Black adults have higher incidence and mortality rates from sepsis compared to Non-Hispanic White adults. A limited number of studies have traced survival outcomes to molecular changes; however, these studies primarily only included Non-Hispanic White adults. Our goal is to better understand molecular changes that may contribute to differences in sepsis survival in African American/Black and Non-Hispanic White adults with primary intra-abdominal infection. We employed discovery-based plasma proteomics of patient samples from the Protocolized Care for Early Septic Shock (ProCESS) cohort (N = 107). We identified 49 proteins involved in the acute phase response and complement system whose expression levels are associated with both survival outcome and racial background. Additionally, 82 proteins differentially-expressed in survivors were specific to African American/Black or Non-Hispanic White patients, suggesting molecular-level heterogeneity in sepsis patients in key inflammatory pathways. A smaller, robust set of 19 proteins were in common in African American/Black and Non-Hispanic White survivors and may represent potential universal molecular changes in sepsis. Overall, this study identifies molecular factors that may contribute to differences in survival outcomes in African American/Black patients that are not fully explained by socioeconomic or other non-biological factors.
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Affiliation(s)
- Kathryn L Kapp
- Department of Chemistry, Vanderbilt University, 5423 Stevenson Center, Nashville, TN, 37235, USA.,The Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, 32732, USA.
| | - Albert B Arul
- Department of Chemistry, Vanderbilt University, 5423 Stevenson Center, Nashville, TN, 37235, USA
| | - Kevin C Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.,Vanderbilt Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Sachin Yende
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA.,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA
| | - John A Kellum
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Derek C Angus
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA.,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA
| | - Octavia M Peck-Palmer
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA.,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA.,Department of Pathology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Renã A S Robinson
- Department of Chemistry, Vanderbilt University, 5423 Stevenson Center, Nashville, TN, 37235, USA.,The Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, 32732, USA.
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19
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Lehman KD. Evidence-based updates to the 2021 Surviving Sepsis Campaign guidelines Part 2: Guideline review and clinical application. Nurse Pract 2022; 47:28-35. [PMID: 36399145 DOI: 10.1097/01.npr.0000884888.21622.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT NPs should be prepared to screen for sepsis, initiate treatment, and optimize care for sepsis survivors. The 2021 Surviving Sepsis Campaign guidelines offer best practices for identification and management of sepsis and septic shock. This article, second in a 2-part series, presents evidence updates and discusses implications for NPs.
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Affiliation(s)
- Karen D Lehman
- Karen D. Lehman is a hospitalist NP and PRN ED NP at NMC Health in Newton, Kan., an ED NP with Docs Who Care based in Olathe, Kan., and a hospice NP with Harry Hynes Memorial Hospice in Wichita, Kan
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20
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Brinkworth JF, Shaw JG. On race, human variation, and who gets and dies of sepsis. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9544695 DOI: 10.1002/ajpa.24527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica F. Brinkworth
- Department of Anthropology University of Illinois Urbana‐Champaign Urbana Illinois USA
- Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
- Department of Evolution, Ecology and Behavior University of Illinois Urbana‐Champaign Urbana Illinois USA
| | - J. Grace Shaw
- Department of Anthropology University of Illinois Urbana‐Champaign Urbana Illinois USA
- Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
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21
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Social Determinants of Health Associated With the Development of Sepsis in Adults: A Scoping Review. Crit Care Explor 2022; 4:e0731. [PMID: 36818749 PMCID: PMC9937691 DOI: 10.1097/cce.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Evaluating risk for sepsis is complicated due to limited understanding of how social determinants of health (SDoH) influence the occurence of the disease. This scoping review aims to identify gaps and summarize the existing literature on SDoH and the development of sepsis in adults. DATA SOURCES A literature search using key terms related to sepsis and SDoH was conducted using Medline and PubMed. STUDY SELECTION Studies were screened by title and abstract and then full text in duplicate. Articles were eligible for inclusion if they: 1) evaluated at least one SDoH on the development of sepsis, 2) participants were 18 years or older, and 3) the studies were written in English between January 1970 and January 2022. Systematic reviews, meta-analyses, editorials, letters, commentaries, and studies with nonhuman participants were excluded. DATA EXTRACTION Data were extracted in duplicate using a standardized data extraction form. Studies were grouped into five categories according to the SDoH they evaluated (race, socioeconomic status [SES], old age and frailty, health behaviors, and social support). The study characteristics, key outcomes related to incidence of sepsis, mortality, and summary statements were included in tables. DATA SYNTHESIS The search identified 637 abstracts, 20 of which were included after full-text screening. Studies evaluating SES, old age, frailty, and gender demonstrated an association between sepsis incidence and the SDoH. Studies that examined race demonstrated conflicting conclusions as to whether Black or White patients were at increased risk of sepsis. Overall, a major limitation of this analysis was the methodological heterogeneity between studies. CONCLUSIONS There is evidence to suggest that SDoH impacts sepsis incidence, particularly SES, gender, old age, and frailty. Future prospective cohort studies that use standardized methods to collect SDoH data, particularly race-based data, are needed to inform public health efforts to reduce the incidence of sepsis and help clinicians identify the populations most at risk.
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22
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Oud L, Garza J. Temporal Trends in Rural vs Urban Sepsis-Related Mortality in the United States, 2010-2019. Chest 2022; 162:132-135. [DOI: 10.1016/j.chest.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 10/19/2022] Open
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23
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Detelich JF, Kyaw NT, Judd SE, Bennett A, Wang HE, Kramer MR, Waller LA, Martin GS, Kempker JA. Home-to-Hospital Distance and Outcomes Among Community-Acquired Sepsis Hospitalizations. Ann Epidemiol 2022; 72:26-31. [PMID: 35551996 PMCID: PMC9629891 DOI: 10.1016/j.annepidem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the hypothesis that longer distance from home-to-hospital is associated with worse outcomes among hospitalizations for community-acquired sepsis. METHODS A secondary analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) prospective cohort of 30,239 white and black US adults ≥ 45 years old was conducted. Self-reported hospitalizations for serious infection between 2003-2012 fulfilling 2/4 systemic inflammatory response syndrome criteria were included. Estimated driving distance was derived from geocoded data and evaluated continuously and as quartiles of very close, close, far, very far (<3.1, 3.1-5.8, 5.9-11.5, and >11.5 miles respectively). The primary outcome was 30-day mortality while the secondary outcome was sequential organ failure assessment (SOFA) score on arrival. RESULTS 912 hospitalizations for community-acquired sepsis had adequate data for analysis. The median (interquartile range) estimated driving distance was 5.8 miles (3.1,11.7), and 54 (5.9%) experienced the primary outcome. Compared to living very close, participants living very far had a mortality odds ratio of 1.30 (95% CI 0.64,2.62) and presenting SOFA score difference of 0.33 (95% CI -0.03,0.68). CONCLUSIONS Among a national sample of community-acquired sepsis hospitalizations, there was no significant association between home-to-hospital distance and either 30-day mortality or SOFA score on hospital presentation.
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Affiliation(s)
- Joshua F Detelich
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA.
| | - Nang Thu Kyaw
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Aleena Bennett
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jordan A Kempker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
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24
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Estrada LV, Levasseur JL, Maxim A, Benavidez GA, Pollack Porter KM. Structural Racism, Place, and COVID-19: A Narrative Review Describing How We Prepare for an Endemic COVID-19 Future. Health Equity 2022; 6:356-366. [PMID: 35651360 PMCID: PMC9148659 DOI: 10.1089/heq.2021.0190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/17/2022] Open
Abstract
Background: Place is a social determinant of health, as recently evidenced by COVID-19. Previous literature surrounding health disparities in the United States often fails to acknowledge the role of structural racism on place-based health disparities for historically marginalized communities (i.e., Black and African American communities, Hispanic/Latinx communities, Indigenous communities [i.e., First Nations, Native American, Alaskan Native, and Native Hawaiian], and Pacific Islanders). This narrative review summarizes the intersection between structural racism and place as contributors to COVID-19 health disparities. Methods: This narrative review accounts for the unique place-based health care experiences influenced by structural racism, including health systems and services and physical environment. We searched online databases for peer-reviewed and governmental sources, published in English between 2000 and 2021, related to place-based U.S. health inequities in historically marginalized communities. We then narrate the link between the historical trajectory of structural racism and current COVID-19 health outcomes for historically marginalized communities. Results: Structural racism has infrequently been named as a contributor to place as a social determinant of health. This narrative review details how place is intricately intertwined with the results of structural racism, focusing on one's access to health systems and services and physical environment, including the outdoor air and drinking water. The role of place, health disparities, and structural racism has been starkly displayed during the COVID-19 pandemic, where historically marginalized communities have been subject to greater rates of COVID-19 incidence and mortality. Conclusion: As COVID-19 becomes endemic, it is crucial to understand how place-based inequities and structural racism contributed to the COVID-19 racial disparities in incidence and mortality. Addressing structurally racist place-based health inequities through anti-racist policy strategies is one way to move the United States toward achieving health equity.
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Affiliation(s)
- Leah V. Estrada
- Center for Health Policy, Columbia University School of Nursing, New York, New York, USA
| | - Jessica L. Levasseur
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Alexandra Maxim
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Gabriel A. Benavidez
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Keshia M. Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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25
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Bozigar M, Lawson AB, Pearce JL, Svendsen ER, Vena JE. Using Bayesian time-stratified case-crossover models to examine associations between air pollution and "asthma seasons" in a low air pollution environment. PLoS One 2021; 16:e0260264. [PMID: 34879071 PMCID: PMC8654232 DOI: 10.1371/journal.pone.0260264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Many areas of the United States have air pollution levels typically below Environmental Protection Agency (EPA) regulatory limits. Most health effects studies of air pollution use meteorological (e.g., warm/cool) or astronomical (e.g., solstice/equinox) definitions of seasons despite evidence suggesting temporally-misaligned intra-annual periods of relative asthma burden (i.e., “asthma seasons”). We introduce asthma seasons to elucidate whether air pollutants are associated with seasonal differences in asthma emergency department (ED) visits in a low air pollution environment. Within a Bayesian time-stratified case-crossover framework, we quantify seasonal associations between highly resolved estimates of six criteria air pollutants, two weather variables, and asthma ED visits among 66,092 children ages 5–19 living in South Carolina (SC) census tracts from 2005 to 2014. Results show that coarse particulates (particulate matter <10 μm and >2.5 μm: PM10-2.5) and nitrogen oxides (NOx) may contribute to asthma ED visits across years, but are particularly implicated in the highest-burden fall asthma season. Fine particulate matter (<2.5 μm: PM2.5) is only associated in the lowest-burden summer asthma season. Relatively cool and dry conditions in the summer asthma season and increased temperatures in the spring and fall asthma seasons are associated with increased ED visit odds. Few significant associations in the medium-burden winter and medium-high-burden spring asthma seasons suggest other ED visit drivers (e.g., viral infections) for each, respectively. Across rural and urban areas characterized by generally low air pollution levels, there are acute health effects associated with particulate matter, but only in the summer and fall asthma seasons and differing by PM size.
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Affiliation(s)
- Matthew Bozigar
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Erik R. Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
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26
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063-e1143. [PMID: 34605781 DOI: 10.1097/ccm.0000000000005337] [Citation(s) in RCA: 923] [Impact Index Per Article: 307.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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27
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Minejima E, Wong-Beringer A. Impact of Socioeconomic Status and Race on Sepsis Epidemiology and Outcomes. J Appl Lab Med 2021; 6:194-209. [PMID: 33241269 DOI: 10.1093/jalm/jfaa151] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Socioeconomic status (SES) is a complex variable that is derived primarily from an individual's education, income, and occupation and has been found to be inversely related to outcomes of health conditions. Sepsis is the sixth most common admitting diagnosis and one of the most costly conditions for in-hospital spending in the United States. The objective of this review is to report on the relationship between SES and sepsis incidence and associated outcomes. CONTENT Sepsis epidemiology varies when explored by race, education, geographic location, income, and insurance status. Sepsis incidence was significantly increased in individuals of Black race compared with non-Hispanic white race; in persons who have less formal education, who lack insurance, and who have low income; and in certain US regions. People with low SES are likely to have onset of sepsis significantly earlier in life and to have poorly controlled comorbidities compared with those with higher SES. Sepsis mortality and hospital readmission is increased in individuals who lack insurance, who reside in low-income or medically underserved areas, who live far from healthcare, and who lack higher level education; however, a person's race was not consistently found to increase mortality. SUMMARY Interventions to minimize healthcare disparity for individuals with low SES should target sepsis prevention with increasing measures for preventive care for chronic conditions. Significant barriers described for access to care by people with low SES include cost, transportation, poor health literacy, and lack of a social network. Future studies should include polysocial risk scores that are consistently defined to allow for meaningful comparison across studies.
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Affiliation(s)
- Emi Minejima
- Department of Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA.,Department of Pharmacy, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA
| | - Annie Wong-Beringer
- Department of Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA.,Department of Pharmacy, Huntington Hospital, Pasadena, CA, USA
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28
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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181-1247. [PMID: 34599691 PMCID: PMC8486643 DOI: 10.1007/s00134-021-06506-y] [Citation(s) in RCA: 1507] [Impact Index Per Article: 502.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Rhodes
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Flávia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Hospital of São Paulo, São Paulo, Brazil
| | | | | | - Hallie C Prescott
- University of Michigan and VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | | | - Steven Simpson
- University of Kansas Medical Center, Kansas City, KS, USA
| | - W Joost Wiersinga
- ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, Emirates University, Al Ain, United Arab Emirates
| | - Derek C Angus
- University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA
| | - Yaseen Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Luciano Azevedo
- School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Lisa Burry
- Mount Sinai Hospital & University of Toronto (Leslie Dan Faculty of Pharmacy), Toronto, ON, Canada
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - John Centofanti
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Angel Coz Yataco
- Lexington Veterans Affairs Medical Center/University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Kent Doi
- The University of Tokyo, Tokyo, Japan
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Shevin Jacob
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Klompas
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Younsuck Koh
- ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Anand Kumar
- University of Manitoba, Winnipeg, MB, Canada
| | - Arthur Kwizera
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzana Lobo
- Intensive Care Division, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Henry Masur
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | | | | | - Yatin Mehta
- Medanta the Medicity, Gurugram, Haryana, India
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Nunnally
- New York University School of Medicine, New York, NY, USA
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tiffany Osborn
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Michael Puskarich
- University of Minnesota/Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jason Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | | | | | | | - Charles L Sprung
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tobias Welte
- Medizinische Hochschule Hannover and German Center of Lung Research (DZL), Hannover, Germany
| | - Janice Zimmerman
- World Federation of Intensive and Critical Care, Brussels, Belgium
| | - Mitchell Levy
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island & Rhode Island Hospital, Providence, RI, USA
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29
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Rose N, Matthäus-Krämer C, Schwarzkopf D, Scherag A, Born S, Reinhart K, Fleischmann-Struzek C. Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany - an ecological study. BMC Public Health 2021; 21:1636. [PMID: 34493250 PMCID: PMC8424852 DOI: 10.1186/s12889-021-11629-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking. Methods Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions. Results In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts. Conclusions Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11629-4.
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Affiliation(s)
- Norman Rose
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Claudia Matthäus-Krämer
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Daniel Schwarzkopf
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Sebastian Born
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carolin Fleischmann-Struzek
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany. .,Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Wang GS, You KM, Jo YH, Lee HJ, Shin JH, Jung YS, Hwang JE. Association of Health Insurance Status with Outcomes of Sepsis in Adult Patients: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115777. [PMID: 34072210 PMCID: PMC8198413 DOI: 10.3390/ijerph18115777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Sepsis is a life-threatening disease, and various demographic and socioeconomic factors affect outcomes in sepsis. However, little is known regarding the potential association between health insurance status and outcomes of sepsis in Korea. We evaluated the association of health insurance and clinical outcomes in patients with sepsis. (2) Methods: Prospective cohort data of adult patients with sepsis and septic shock from March 2016 to December 2018 in three hospitals were retrospectively analyzed. We categorized patients into two groups according to their health insurance status: National Health Insurance (NHI) and Medical Aid (MA). The primary end point was in-hospital mortality. The multivariate logistic regression model and propensity score matching were used. (3) Results: Of a total of 2526 eligible patients, 2329 (92.2%) were covered by NHI, and 197 (7.8%) were covered by MA. The MA group had fewer males, more chronic kidney disease, more multiple sources of infection, and more patients with initial lactate > 2 mmol/L. In-hospital, 28-day, and 90-day mortality were not significantly different between the two groups and in-hospital mortality was not different in the subgroup analysis. Furthermore, health insurance status was not independently associated with in-hospital mortality in multivariate analysis and was not associated with survival outcomes in the propensity score-matched cohort. (4) Conclusions: Our propensity score-matched cohort analysis demonstrated that there was no significant difference in in-hospital mortality by health insurance status in patients with sepsis.
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Affiliation(s)
- Gaon-Sorae Wang
- Department of Emergency Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea; (G.-S.W.); (Y.-S.J.)
| | - Kyoung-Min You
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea; (H.-J.L.); (J.-H.S.)
- Correspondence: (K.-M.Y.); (Y.-H.J.); Tel.: +82-10-8525-4298 (K.-M.Y.); +82-10-4579-7255 (Y.-H.J.)
| | - You-Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea;
- Department of Emergency Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Correspondence: (K.-M.Y.); (Y.-H.J.); Tel.: +82-10-8525-4298 (K.-M.Y.); +82-10-4579-7255 (Y.-H.J.)
| | - Hui-Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea; (H.-J.L.); (J.-H.S.)
| | - Jong-Hwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea; (H.-J.L.); (J.-H.S.)
- Department of Emergency Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Yoon-Sun Jung
- Department of Emergency Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea; (G.-S.W.); (Y.-S.J.)
| | - Ji-Eun Hwang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea;
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Galiatsatos P, Page KR, Chatterjee S, Maygers J, Sarker S, Jones V, Lugo A, Tolson T, Hill-Briggs F, Chen ES, Golden SH. Comparing Critical Care Admissions Among Urban Populations Before and During the COVID-19 Pandemic. Health Secur 2021; 19:S34-S40. [PMID: 33944605 DOI: 10.1089/hs.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the context of the COVID-19 pandemic, reassessing intensive care unit (ICU) use by population should be a priority for hospitals planning for critical care resource allocation. In our study, we reviewed the impact of COVID-19 on a community hospital serving an urban region, comparing the sociodemographic distribution of ICU admissions before and during the pandemic. We executed a time-sensitive analysis to see if COVID-19 ICU admissions reflect the regional sociodemographic populations and ICU admission trends before the pandemic. Sociodemographic variables included sex, race, ethnicity, and age of adult patients (ages 18 years and older) admitted to the hospital's medical and cardiac ICUs, which were converted to COVID-19 ICUs. The time period selected was 18 months, which was then dichotomized into pre-COVID-19 admissions (December 1, 2018 to March 13, 2020) and COVID-19 ICU admissions (March 14 to May 31, 2020). Variables were compared using Fisher's exact tests and Wilcoxon tests when appropriate. During the 18-month period, 1,861 patients were admitted to the aforementioned ICUs. The mean age of the patients was 62.75 (SD 15.57), with the majority of these patients being male (52.23%), White (64.43%), and non-Hispanic/Latinx (95.75%). Differences were found in racial and ethnic distribution comparing pre-COVID-19 admissions to COVID-19 admissions. Compared with pre-COVID-19 ICU admissions, we found an increase in African American versus White admissions (P = .01) and an increase in Hispanic/Latinx versus non-Hispanic/Latinx admissions (P < .01), during the COVID-19 pandemic. During the first 3 months of admissions to COVID-19 ICUs, the number of admissions among Hispanic/Latinx and African American patients increased while the number of admissions among non-Hispanic/Latinx and White patient decreased, compared with the pre-COVID-19 period. These findings support development of strategies to enhance allocation of resources to bolster novel, equitable strategies to mitigate the incidence of COVID-19 in urban populations.
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Affiliation(s)
- Panagis Galiatsatos
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Kathleen R Page
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Souvik Chatterjee
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Joyce Maygers
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Sauradeep Sarker
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Vanya Jones
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - April Lugo
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Tina Tolson
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Felicia Hill-Briggs
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Edward S Chen
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
| | - Sherita H Golden
- Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD
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Brahmania M, Wiskar K, Walley KR, Celi LA, Rush B. Lower household income is associated with an increased risk of hospital readmission in patients with decompensated cirrhosis. J Gastroenterol Hepatol 2021; 36:1088-1094. [PMID: 32562577 PMCID: PMC8063220 DOI: 10.1111/jgh.15153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM The impact of household income, a surrogate of socioeconomic status, on hospital readmission rates for patients with decompensated cirrhosis has not been well characterized. METHODS The Nationwide Readmission Database from 2012 to 2014 was used to study the association of lower median household income on 30-, 90-, and 180-day hospital readmission rates for patients with decompensated cirrhosis. RESULTS From the 42 679 001 hospital admissions contained in the sample, there were 82 598 patients with decompensated cirrhosis who survived a hospital admission in the first 6 months of the year. During a uniform 6-month follow-up period, 25 914 (31.4%), 39 928 (48.3%), and 47 496 (57.5%) patients were readmitted at 30, 90, and 180 days, respectively. After controlling for demographic and clinical confounders, patients residing in the three lowest income quartiles were significantly more likely to be readmitted at 30 days than those in the fourth quartile (first quartile, odds ratio [OR] 1.32 [95% confidence interval, CI, 1.17-1.47, P < 0.01]; second quartile, OR 1.25 [95% CI 1.13-1.38, P < 0.01]; and third quartile, OR 1.08 [95% CI 0.97-1.20, P = 0.07]). The association between lower socioeconomic status and the higher risk of readmissions persisted at 90 days (first quartile, OR 1.21 [95% CI 1.14-1.30, P < 0.01]) and 180 days (first quartile, OR 1.32 [95% CI 1.20-1.44, P < 0.01]). CONCLUSION Patients with decompensated cirrhosis residing in the lowest income quartile had a 32% higher odds of hospital readmissions at 30, 90, and 180 days compared with those in the highest income quartile.
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Affiliation(s)
- Mayur Brahmania
- Department of Medicine, Division of Gastroenterology, London Health Sciences Center, Western University, London, Ontario
| | - Katie Wiskar
- Department of Medicine, Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia
| | - Keith R Walley
- Department of Medicine, Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia,,Center for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia
| | - Leo A Celi
- Department of Medicine, Division of Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA
| | - Barret Rush
- Department of Internal Medicine, Division of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Ramadurai D, Sarcone EE, Kearns MT, Neumeier A. A Case-Based Critical Care Curriculum for Internal Medicine Residents Addressing Social Determinants of Health. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11128. [PMID: 33816790 PMCID: PMC8015637 DOI: 10.15766/mep_2374-8265.11128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Graduate medical education on social determinants of health (SDOH) is limited. Residents often directly care for vulnerable populations at safety-net hospitals, yet curricula thus far are based in the ambulatory setting. METHODS We developed a case-based curriculum integrating SDOH with critical care topics to standardize knowledge and improve skills and attitudes of internal medicine residents working with these patients. We conducted a needs assessment, identified systematic social risk domains, and modified a published curriculum to develop the content. Case-based discussions were conducted weekly in the medical intensive care unit, while knowledge, attitudes, and skills were assessed daily during multidisciplinary rounds. A 360-degree assessment was completed with pre- and postcurriculum surveys and self-reflection. RESULTS Eleven residents completed postcurriculum surveys. Both pre- and postcurriculum, residents reported confidence in identifying and describing how SDOH affect care. After the curriculum, residents could name more resources for patients experiencing health disparities due to substance abuse (pre: 47%, post: 73%) and financial constraints (pre: 50%, post:64%). This curriculum was recognized as the first training many residents received (pre: 31%, post: 91%) with formal feedback (pre: 16%, post: 64%). DISCUSSION Implementing a curriculum of social risk assessment in critically ill patients was difficult due to competition with clinical care. Participating residents said they "loved the open dialogue" to reflect on their experiences; this became an avenue to "debrief on specific patient encounters and [how] SDOH brought [patients] to the ICU." Future directions include qualitative analysis of reflections and assessment of curricular impact on trainee resiliency.
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Affiliation(s)
- Deepa Ramadurai
- Fellow of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania
| | - Ellen E. Sarcone
- Assistant Professor, Division of Hospital Medicine, Denver Health and Hospital Authority
| | - Mark T. Kearns
- Assistant Professor, Division of Pulmonary Sciences and Critical Care Medicine, Denver Health and Hospital Authority; Assistant Professor, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus
| | - Anna Neumeier
- Assistant Professor, Division of Pulmonary Sciences and Critical Care Medicine, Denver Health and Hospital Authority; Assistant Professor, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus
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Minejima E, Wang J, Boettcher S, Liu L, Lou M, She RC, Wenzel SL, Spellberg B, Wong-Beringer A. Distance Between Home and the Admitting Hospital and Its Effect on Survival of Low Socioeconomic Status Population With Staphylococcus aureus Bacteremia. Public Health Rep 2021; 137:110-119. [PMID: 33715536 PMCID: PMC8721749 DOI: 10.1177/0033354921994897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Bacteremia is the presence of bacteria in the bloodstream. The objective of this study was to determine the relationship between low socioeconomic status (SES) and the epidemiology, process of care, and outcomes of patients with Staphylococcus aureus bacteremia (SAB). METHODS We conducted a multicenter, retrospective, cohort study that evaluated adult patients with SAB in 3 Los Angeles County hospitals from July 15, 2012, through May 31, 2018. We determined SES (low SES, intermediate SES, and high SES) for each patient and compared sociodemographic and epidemiologic characteristics, management of care received by patients with SAB (ie, process of care), and outcomes. We used a Cox proportional hazards model to determine predictors of 30-day mortality for each SES group. RESULTS Of 915 patients included in the sample, 369 (40%) were in the low-SES group, 294 (32%) in the intermediate-SES group, and 252 (28%) in the high-SES group. Most significant predictors of 30-day mortality in the Cox proportional hazards model were admission to an intensive care unit (hazard ratio [HR] = 9.04; 95% CI, 4.26-19.14), Pitt bacteremia score ≥4 indicating critical illness (HR = 4.30; 95% CI, 2.49-7.44), having ≥3 comorbidities (HR = 2.05; 95% CI, 1.09-3.85), and advanced age (HR = 1.03; 95% CI, 1.01-1.05). Distance between home and admitting hospital affected mortality only in the low-SES group (HR = 1.02; 95% CI, 1.00-1.02). CONCLUSIONS SES did not independently affect the outcome of SAB; however, the farther the patient's residence from the hospital, the greater the negative effect on survival in a low-SES population. Our findings underscore the need to develop multipronged, targeted public health efforts for populations that have transportation barriers to health care.
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Affiliation(s)
- Emi Minejima
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA,Los Angeles County–University of Southern California Medical Center, Los Angeles, CA, USA
| | - Joshua Wang
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Stormmy Boettcher
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Lihua Liu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mimi Lou
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Rosemary C. She
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Suzanne L. Wenzel
- Department of Adults and Healthy Aging, University of Southern California School of Social Work, Los Angeles, CA, USA
| | - Brad Spellberg
- Los Angeles County–University of Southern California Medical Center, Los Angeles, CA, USA
| | - Annie Wong-Beringer
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA,Department of Pharmacy, Huntington Hospital, Pasadena, CA, USA,Annie Wong-Beringer, PharmD, University of Southern California School of Pharmacy, 1985 Zonal Ave, Los Angeles, CA 90033, USA.
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Peach BC, Li Y, Cimiotti JP. Urosepsis in Older Adults: Epidemiologic Trends in Florida. J Aging Soc Policy 2021; 34:626-640. [PMID: 33413039 DOI: 10.1080/08959420.2020.1851432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The incidence and geographic distribution of urosepsis, a life-threatening condition in older adults, is not well understood. The Florida State Inpatient Databases (2012-2014) showed an increase in the incidence of community-acquired urosepsis (5.37 to 6.16 per 1000), particularly among Hispanic older adults residing in low socioeconomic, urban areas with large numbers of nursing homes. These findings suggest a state policy is needed to address community-based preventative care and education for early detection of urosepsis in low-income urban areas. It is important for local health departments to partner with nursing homes to address disparities in care that disproportionally impact Hispanics.
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Affiliation(s)
- Brian C Peach
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jeannie P Cimiotti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Reddy AR, Badolato GM, Chamberlain JM, Goyal MK. Disparities Associated with Sepsis Mortality in Critically Ill Children. J Pediatr Intensive Care 2020; 11:147-152. [DOI: 10.1055/s-0040-1721730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022] Open
Abstract
AbstractDisparities in health care related to socioeconomic status and race/ethnicity are well documented in adult and neonatal sepsis, but they are less characterized in the critically ill pediatric population. This study investigated whether socioeconomic status and/or race/ethnicity is associated with mortality among children treated for sepsis in the pediatric intensive care unit (PICU). A retrospective cohort study was conducted using information from 48 children's hospitals included in the Pediatric Health Information System database. We included visits by children ≤ 21 years with All Patients Refined Diagnosis-Related Groups (APR-DRG) diagnosis codes of septicemia and disseminated infections that resulted in PICU admission from 2010 to 2016. Multivariable logistic regression was used to measure the effect of race/ethnicity and socioeconomic status (insurance status and median household income for zip code) on mortality after adjustment for age, gender, illness severity, and presence of complex chronic condition. Among the 14,276 patients with sepsis, the mortality rate was 6.8%. In multivariable analysis, socioeconomic status, but not race/ethnicity, was associated with mortality. In comparison to privately insured children, nonprivately insured children had increased odds of mortality (public: adjusted odds ratio [aOR]: 1.2 [1.0, 1.5]; uninsured: aOR: 2.1 [1.2, 3.7]). Similarly, children living in zip codes with the lowest quartile of annual household income had higher odds of mortality than those in the highest quartile (aOR: 1.5 [1.0, 2.2]). These data suggest the presence of socioeconomic, but not racial/ethnic, disparities in mortality among children treated for sepsis. Further research is warranted to understand why such differences exist and how they may be addressed.
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Affiliation(s)
- Anireddy R. Reddy
- Department of Pediatrics, Children’s National Medical Center, Washington, District of Columbia, United States
| | - Gia M. Badolato
- Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
| | - James M. Chamberlain
- Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
| | - Monika K. Goyal
- Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
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Bozigar M, Faith TD, White AA, Drayton KD, Fabick A, Cartmell KB. A Cross-Sectional Survey to Evaluate Potential for Partnering With School Nurses to Promote Human Papillomavirus Vaccination. Prev Chronic Dis 2020; 17:E111. [PMID: 32975509 PMCID: PMC7553228 DOI: 10.5888/pcd17.190451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The human papillomavirus (HPV) increases the risk for cancers of the cervix, oropharynx, vulva, vagina, penis, and anus. HPV vaccination rates are low in many states having large medically underserved areas. In such areas, school nurses are a potential partner for improving population health, but their perceptions about HPV, HPV vaccination, and their role in promoting HPV vaccination have not been well documented. METHODS We administered a cross-sectional survey to 61 of 74 lead school nurses at their 2019 annual training session in South Carolina. Survey questions assessed lead school nurses' HPV vaccination beliefs, barriers, and HPV vaccination role in schools. We tabulated descriptive data and created heat maps to visualize correlations between responses. RESULTS Despite 95.1% of nurses envisioning a role in supporting HPV vaccination at their schools, only 41.0% envisioned an active role in promoting HPV vaccine among students. Lead nurses consistently believed in vaccinating both male and female students; in vaccine safety, effectiveness, and health benefits; and in recommending HPV vaccination. The nurses agreed that lack of time and competing priorities were barriers to HPV vaccination. Few other barriers were consistently identified. CONCLUSION Partnering with school nurses may be a feasible strategy to overcome barriers to increasing HPV vaccination rates in medically underserved areas. However, to increase nurses' confidence and time allotment to assume an active role in HPV vaccine promotion in their schools, coordinated and sustained partnerships between public health agencies, school districts, and school nurses are needed.
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Affiliation(s)
- Matthew Bozigar
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Ste 301, Charleston, SC 29425.
| | - Trevor D Faith
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina
| | - Ashley A White
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Ka'la D Drayton
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Allison Fabick
- College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina
| | - Kathleen B Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
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Sterba KR, Johnson EE, Nadig N, Simpson AN, Simpson KN, Goodwin AJ, Beeks R, Warr EH, Zapka J, Ford DW. Determinants of Evidence-based Practice Uptake in Rural Intensive Care Units. A Mixed Methods Study. Ann Am Thorac Soc 2020; 17:1104-1116. [PMID: 32421348 PMCID: PMC7722472 DOI: 10.1513/annalsats.202002-170oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/18/2020] [Indexed: 12/29/2022] Open
Abstract
Rationale: Evidence-based practices promote quality care for intensive care unit patients but chronic evidence-to-practice gaps limit their reach.Objectives: To characterize key determinants of evidence-based practice uptake in the rural intensive care setting.Methods: A parallel convergent mixed methods design was used with six hospitals receiving a quality improvement intervention. Guided by implementation science principles, we identified barriers and facilitators to uptake using clinician surveys (N = 90), key informant interviews (N = 14), and an implementation tracking log. Uptake was defined as completion of eight practice change steps within 12 months. After completing qualitative and quantitative data analyses for each hospital, site, staff, and program delivery factors were summarized within and across hospitals to identify patterns by uptake status.Results: At the site level, although structural characteristics (hospital size, intensivist staffing) did not vary by uptake status, interviews highlighted variability in staffing patterns and culture that differed by uptake status. At the clinician team level, readiness and self-efficacy were consistently high across sites at baseline with time and financial resources endorsed as primary barriers. However, interviews highlighted that as initiatives progressed, differences across sites in attitudes and ownership of change were key uptake influences. At the program delivery level, mixed methods data highlighted program engagement and leadership variability by uptake status. Higher uptake sites had better training attendance; more program activities completed; and a stable, engaged, collaborative nurse and physician champion team.Conclusions: Results provide an understanding of the multiple dynamic influences on different patterns of evidence-based practice uptake and the importance of implementation support strategies to accelerate uptake in the intensive care setting.
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Affiliation(s)
| | | | - Nandita Nadig
- Telehealth Center of Excellence
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, and
| | - Annie N. Simpson
- Telehealth Center of Excellence
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina
| | - Kit N. Simpson
- Telehealth Center of Excellence
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina
| | - Andrew J. Goodwin
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, and
| | | | | | | | - Dee W. Ford
- Telehealth Center of Excellence
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, and
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Fleischmann-Struzek C, Mellhammar L, Rose N, Cassini A, Rudd KE, Schlattmann P, Allegranzi B, Reinhart K. Incidence and mortality of hospital- and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. Intensive Care Med 2020; 46:1552-1562. [PMID: 32572531 PMCID: PMC7381468 DOI: 10.1007/s00134-020-06151-x] [Citation(s) in RCA: 327] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022]
Abstract
Purpose To investigate the global burden of sepsis in hospitalized adults by updating and expanding a systematic review and meta-analysis and to compare findings with recent Institute for Health Metrics and Evaluation (IHME) sepsis estimates. Methods Thirteen electronic databases were searched for studies on population-level sepsis incidence defined according to clinical criteria (Sepsis-1, -2: severe sepsis criteria, or sepsis-3: sepsis criteria) or relevant ICD-codes. The search of the original systematic review was updated for studies published 05/2015–02/2019 and complemented by a search targeting low- or middle-income-country (LMIC) studies published 01/1979–02/2019. We performed a random-effects meta-analysis with incidence of hospital- and ICU-treated sepsis and proportion of deaths among these sepsis cases as outcomes. Results Of 4746 results, 28 met the inclusion criteria. 21 studies contributed data for the meta-analysis and were pooled with 30 studies from the original meta-analysis. Pooled incidence was 189 [95% CI 133, 267] hospital-treated sepsis cases per 100,000 person-years. An estimated 26.7% [22.9, 30.7] of sepsis patients died. Estimated incidence of ICU-treated sepsis was 58 [42, 81] per 100,000 person-years, of which 41.9% [95% CI 36.2, 47.7] died prior to hospital discharge. There was a considerably higher incidence of hospital-treated sepsis observed after 2008 (+ 46% compared to the overall time frame). Conclusions Compared to results from the IHME study, we found an approximately 50% lower incidence of hospital-treated sepsis. The majority of studies included were based on administrative data, thus limiting our ability to assess temporal trends and regional differences. The incidence of sepsis remains unknown for the vast majority of LMICs, highlighting the urgent need for improved epidemiological sepsis surveillance. Electronic supplementary material The online version of this article (10.1007/s00134-020-06151-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - L Mellhammar
- Division of Infection Medicine, Department of Clinical Sciences, University of Lund, Lund, Sweden
| | - N Rose
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - A Cassini
- Infection Prevention and Control Hub, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - K E Rudd
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - P Schlattmann
- Institute for Medical Statistics, Computer Science and Data Science, Jena University Hospital, Jena, Germany
| | - B Allegranzi
- Infection Prevention and Control Hub, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - K Reinhart
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany. .,Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany. .,Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Chao WC, Wang CY, Hsu BC, Lin CH, Huang WN, Chen YH, Wu CL, Chen HH. Factors associated with sepsis risk in immune-mediated inflammatory diseases receiving tumor necrosis factor inhibitors: a nationwide study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20929208. [PMID: 32595776 PMCID: PMC7298427 DOI: 10.1177/1759720x20929208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/30/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Risk factors for sepsis have not been assessed in patients receiving tumor
necrosis factor-alpha inhibitors (TNFi) for immune-mediated inflammatory
diseases (IMIDs) who are vulnerable to serious/hospitalized infections. Methods: Data from 2003–2017 were obtained from Taiwan’s National Health Insurance
Research Database to identify patients receiving TNFi, including etanercept,
adalimumab, and golimumab, for IMIDs including rheumatoid arthritis (RA),
ankylosing spondylitis (AS), psoriasis (PsO), psoriatic arthritis (PsA),
Crohn’s disease (CD), and ulcerative colitis (UC). To investigate risk
factors for sepsis, we used the Sepsis-3 definition and calculated hazard
ratios (HRs) with 95% confidence intervals (CIs) using Cox regression
analysis. Results: There were 17,764 patients (mean age 49.3 ± 14.3 years; females, 57.6%)
receiving TNFi for IMIDs, including RA (58.6%), AS (19.1%), PsO (15.1%), PsA
(2.5%), CD (3.0%), and UC (1.7%). The overall incidence rate of sepsis was
1088 per 100,000 person-years. After adjustment for potential confounders,
recent sepsis within 3 months before TNFi initiation (HR, 2.35; 95% CI,
1.73–3.20), CD (HR, 3.36; 95% CI 2.11–5.34; reference group: AS) and
glucocorticoid use (prednisolone-equivalent dose, mg/day HR, 1.05; 95% CI,
1.05–1.06) were associated with the risk of sepsis. Intriguingly, golimumab
users appeared to have a lower risk of sepsis compared with etanercept users
(HR, 0.56; 95% CI, 0.38–0.83). In addition, socioeconomic status, including
urbanization level and insured amount, was associated with sepsis in a
dose-response manner. Conclusions: Recent sepsis, CD, concomitant glucocorticoid use, and low socioeconomic
status, which were associated with an increased risk of sepsis, are crucial
for individualized risk management plans.
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Affiliation(s)
- Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, ROC
| | - Chen-Yu Wang
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung
| | - Bo-Chueh Hsu
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - Wen-Nan Huang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, ROC
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Chan KS, Parikh MA, Thorpe RJ, Gaskin DJ. Health Care Disparities in Race-Ethnic Minority Communities and Populations: Does the Availability of Health Care Providers Play a Role? J Racial Ethn Health Disparities 2020; 7:539-549. [PMID: 31845286 PMCID: PMC7231628 DOI: 10.1007/s40615-019-00682-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine disparities in use and access to different health care providers by community and individual race-ethnicity and to test provider supply as a potential mediator. DATA SOURCES National secondary data from 2014 Medical Expenditure Panel Survey, 5-year estimates (2010-2014) from American Community Survey, and 2014 InfoUSA. STUDY DESIGN Multiple logistic regression models examined the association of community and individual race-ethnicity with reported health care visits and access. Mediation analyses tested the role of provider supply. DATA EXTRACTION METHODS Individual-level survey data were linked to race-ethnic composition and health business counts of the respondent's primary care service area (PCSA). PRINCIPAL FINDINGS Minority PCSAs are significantly and independently associated with lower odds of having a visit to a physician assistant/nurse practitioner, dentist, or other health professionals and having a usual care provider (all p < 0.05). Few significant associations were observed for integrated PCSAs or for health provider supply. A modest mediation effect for provider supply was observed for travel time to usual care provider and visit to other health professionals. CONCLUSIONS Use of a range of health services is lower in minority communities and individuals. However, provider supply was not an important explanatory factor of these disparities.
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Affiliation(s)
- Kitty S Chan
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Medstar Health Research Institute, 3800 Reservoir Rd., NW, Gorman 3056, Washington, DC, 20007, USA.
| | - Megha A Parikh
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Darrell J Gaskin
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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MySurgeryRisk: Development and Validation of a Machine-learning Risk Algorithm for Major Complications and Death After Surgery. Ann Surg 2020; 269:652-662. [PMID: 29489489 DOI: 10.1097/sla.0000000000002706] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To accurately calculate the risk for postoperative complications and death after surgery in the preoperative period using machine-learning modeling of clinical data. BACKGROUND Postoperative complications cause a 2-fold increase in the 30-day mortality and cost, and are associated with long-term consequences. The ability to precisely forecast the risk for major complications before surgery is limited. METHODS In a single-center cohort of 51,457 surgical patients undergoing major inpatient surgery, we have developed and validated an automated analytics framework for a preoperative risk algorithm (MySurgeryRisk) that uses existing clinical data in electronic health records to forecast patient-level probabilistic risk scores for 8 major postoperative complications (acute kidney injury, sepsis, venous thromboembolism, intensive care unit admission >48 hours, mechanical ventilation >48 hours, wound, neurologic, and cardiovascular complications) and death up to 24 months after surgery. We used the area under the receiver characteristic curve (AUC) and predictiveness curves to evaluate model performance. RESULTS MySurgeryRisk calculates probabilistic risk scores for 8 postoperative complications with AUC values ranging between 0.82 and 0.94 [99% confidence intervals (CIs) 0.81-0.94]. The model predicts the risk for death at 1, 3, 6, 12, and 24 months with AUC values ranging between 0.77 and 0.83 (99% CI 0.76-0.85). CONCLUSIONS We constructed an automated predictive analytics framework for machine-learning algorithm with high discriminatory ability for assessing the risk of surgical complications and death using readily available preoperative electronic health records data. The feasibility of this novel algorithm implemented in real time clinical workflow requires further testing.
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Double inter-hospital transfer in Sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer. J Crit Care 2019; 56:49-57. [PMID: 31837601 DOI: 10.1016/j.jcrc.2019.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Sepsis is a leading cause of hospital deaths. Inter-hospital transfer is frequent in sepsis and is associated with increased mortality. Some sepsis patients undergo two inter-hospital transfers (double transfer). This study assessed the (1) prevalence, (2) associated risk factors, (3) associated mortality, and (4) hospital length-of-stay and costs of double-transfer of sepsis patients. MATERIALS AND METHODS Retrospective cohort study using 2005-2014 administrative claims data in Iowa. Multivariable generalized estimating equations adjusted for potential confounding variables, with a primary outcome of mortality. Secondary outcomes included hospital length-of-stay and costs. Hospital-specific cost-to-charge ratios estimated hospital costs. Hospitals were categorized into quintiles based on sepsis-volume. RESULTS Of 15,182 sepsis subjects, there were 45.2% non-transfers and 2.1% double-transfers. Double-transfers had worse mortality than non-transfers but not single-transfers. Of the non-transfers, 44.9% presented to a top sepsis-volume hospital compared to 22.8% of double-transfers and 25.1% of single-transfers. After transfer from first to second hospital, 93.4% of the single-transfers and 92.2% of the double-transfers were at a top sepsis-volume hospital. Double-transfers had longer length-of-stay and more in total hospital costs than single-transfers. CONCLUSIONS Double-transfer occurs in 2.1% of Iowa sepsis patients. Double-transfers had similar mortality and increased length of stay and costs compared to single-transfers.
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Donnelly JP, Lakkur S, Judd SE, Levitan EB, Griffin R, Howard G, Safford MM, Wang HE. Association of Neighborhood Socioeconomic Status With Risk of Infection and Sepsis. Clin Infect Dis 2019; 66:1940-1947. [PMID: 29444225 PMCID: PMC6248765 DOI: 10.1093/cid/cix1109] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/12/2018] [Indexed: 02/03/2023] Open
Abstract
Background Prior studies suggest disparities in sepsis risk and outcomes based on place of residence. We sought to examine the association between neighborhood socioeconomic status (nSES) and hospitalization for infection and sepsis. Methods We conducted a prospective cohort study using data from 30239 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. nSES was defined using a score derived from census data and classified into quartiles. Infection and sepsis hospitalizations were identified over the period 2003-2012. We fit Cox proportional hazards models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs) and examining mediation by participant characteristics. Results Over a median follow-up of 6.5 years, there were 3054 hospitalizations for serious infection. Infection incidence was lower for participants in the highest nSES quartile compared with the lowest quartile (11.7 vs 15.6 per 1000 person-years). After adjustment for demographics, comorbidities, and functional status, infection hazards were also lower for the highest quartile (HR, 0.84 [95% CI, .73-.97]), with a linear trend (P = .011). However, there was no association between nSES and sepsis at presentation among those hospitalized with infection. Physical weakness, income, and diabetes had modest mediating effects on the association of nSES with infection. Conclusions Our study shows that differential infection risk may explain nSES disparities in sepsis incidence, as higher nSES is associated with lower infection hospitalization rates, but there is no association with sepsis among those hospitalized. Mediation analysis showed that nSES may influence infection hospitalization risk at least partially through physical weakness, individual income, and comorbid diabetes.
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Affiliation(s)
- John P Donnelly
- Department of Emergency Medicine, University of Alabama School of Medicine.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Sindhu Lakkur
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Russell Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston
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Galiatsatos P, Sun J, Welsh J, Suffredini A. Health Disparities and Sepsis: a Systematic Review and Meta-Analysis on the Influence of Race on Sepsis-Related Mortality. J Racial Ethn Health Disparities 2019; 6:900-908. [PMID: 31144133 PMCID: PMC10875732 DOI: 10.1007/s40615-019-00590-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE Racial disparities in sepsis outcomes have been previously reported. However, recently, there have been inconsistencies in identifying which socioeconomic variables, such as race, account for these disparities. The objective of this study was to perform a systematic review in order to examine the impact of race on sepsis-attributable mortality. METHODS Systematic searches for English-language articles identified through MEDLINE, EBSCOhost, PubMed, ERIC, and Cochrane Library databases from 1960 to 1 February 2017. Included studies examined sepsis outcomes in the context of sepsis incidence and/or mortality. Two investigators independently extracted data and assessed study quality. The meta-analysis was performed in accordance with the Cochrane Collaboration guidelines. RESULTS Twenty-one studies adhered to the predefined selection criteria and were included in the review. Of the 21 studies, we pooled data from 6 studies comparing African American/Black race as a risk factor for sepsis-related mortality disparities (reference group being Caucasian/White). From the meta-analysis on these six studies, African American/Black race was found to have no statistical significant relationship with sepsis-related mortality (odds ratio 1.20, 95% CI, 0.81 to 1.77). Similar results were found for other races (Native Americans, Asians) and ethnicities (Hispanic/Latinos). CONCLUSION On the basis of available evidence from a limited number of observation retrospective studies, race alone cannot fully explain sepsis-related disparities, especially sepsis-attributable mortality.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
- Medicine for the Greater Good at Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Judith Welsh
- Office of Research Services, NIH Library, National Institutes of Health, Bethesda, MD, USA
| | - Anthony Suffredini
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Tian HC, Zhou JF, Weng L, Hu XY, Peng JM, Wang CY, Jiang W, Du XP, Xi XM, An YZ, Duan ML, Du B. Epidemiology of Sepsis-3 in a sub-district of Beijing: secondary analysis of a population-based database. Chin Med J (Engl) 2019; 132:2039-2045. [PMID: 31425273 PMCID: PMC6793784 DOI: 10.1097/cm9.0000000000000392] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China. METHODS The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution. RESULTS Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001) CONCLUSIONS:: This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China. CLINICAL TRIAL REGISTRATION NCT02285257, https://clinicaltrials.gov/ct2/show/record/NCT02285257.
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Affiliation(s)
- Hong-Cheng Tian
- Department of Critical Care Medicine, China Rehabilitation Research Center, Capital Medical University, Beijing 100068, China
| | - Jian-Fang Zhou
- Department of Critical Care Medicine, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
| | - Li Weng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Yun Hu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jin-Min Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chun-Yao Wang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei Jiang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xue-Ping Du
- Department of General Internal Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Xiu-Ming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - You-Zhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Mei-Li Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
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Sepsis quality in safety-net hospitals: An analysis of Medicare's SEP-1 performance measure. J Crit Care 2019; 54:88-93. [PMID: 31400737 DOI: 10.1016/j.jcrc.2019.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Newly enacted policies at the state and federal level in the United States require acute care hospitals to engage in sepsis quality improvement. However, responding to these policies requires considerable resources and may disproportionately burden safety-net hospitals. To better understand this issue, we analyzed the relationship between hospital safety-net status and performance on Medicare's SEP-1 quality measure. MATERIALS AND METHODS We linked multiple publicly-available datasets with information on SEP-1 performance, structural hospital characteristics, hospital financial case mix, and health system affiliation. We analyzed the relationship between hospital safety-net status and SEP-1 performance, as well as whether hospital characteristics moderated that relationship. RESULTS We analyzed data from 2827 hospitals, defining safety-net hospitals using financial case mix data. The 703 safety-net hospitals performed worse on Medicare's SEP-1 quality measure (adjusted difference 2.3% compliance, 95% CI -4.0%--0.6%). This association was most evident in hospitals not affiliated with health systems, in which the difference between safety-net and non-safety-net hospitals was 6.8% compliance (95% CI -10.4%--3.3%). CONCLUSIONS Existing sepsis policies may harm safety-net hospitals and widen health disparities. Our findings suggest that strategies to promote collaboration among hospitals may be an avenue for sepsis performance improvement in safety-net hospitals.
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Hospital Readmissions in Sepsis Survivors: Are They Preventable? Ann Am Thorac Soc 2019; 14:170-171. [PMID: 28146387 DOI: 10.1513/annalsats.201611-836ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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