Black Patients With Sepsis and Acute Respiratory Failure Have Longer Hospital Stays Than White Patients

Black patients presenting at the hospital with sepsis and/or acute respiratory failure (ARF) experienced a longer length of stay (LOS) than White patients, suggesting how racial disparities contribute to adverse outcomes among minority patients in hospital care settings.

“Among potential factors that may play a role in LOS disparities, racism is a key mechanism requiring specific attention,” wrote the researchers of the study. “The consequences and experience of racism are too complex to be captured in our data.”

The results of this cohort study were published in JAMA Network Open.

Although patients belonging to racial and ethnic minority groups, especially Black patients, are known to have the highest burden of disease and death from sepsis and ARF, it remains unclear exactly how these disparities might present themselves during the time of hospitalization. For this reason, the researchers aimed to better understand the prevalence of racial disparities in LOS among patients who are at the high-risk of adverse outcomes.

The retrospective cohort included a total of 102,362 adult patients across 27 hospitals in the Philadelphia metropolitan and northern California areas between January 1, 2013, and December 31, 2018. Of these patients, 84,685 met clinical criteria for sepsis and 42,008 for ARF, who were at high-risk of death at the time of hospitalization but did not need immediate invasive life support.

Of these patients, 10.2% identified as Asian American or Pacific Islander, 13.7% as Black, 9.7% as Hispanic, 60.7% as White, and 5.7% as multiracial. These patients were then matched between June 1, 2022, and July 31, 2022, with White patients to evaluate differences in clinical presentation characteristics, hospital capacity strain, initial intensive care unit admission, and occurrence of inpatient death.

The median age of these patients was 76 years and 51.5% (n = 52,705) were male.

Black patients with sepsis (1.26; 95% CI, 0.68-1.84) and ARF (0.97; 95% CI, 0.05-1.89) were found to have experienced longer LOS in days than White patients. However, LOS in days was shorter among Asian American and Pacific Islander patients with ARF (–0.61; 95% CI, –0.88 to –0.34) and Hispanic patients with sepsis (–0.22; 95% CI, –0.39 to –0.05) or ARF (–0.47; 95% CI, –0.73 to –0.20).

Because these matched differences were found to be independent of clinical presentation factors, the researchers believe that different factors associated with racial disparities should also be considered in future studies, such as socioeconomic status factors that pertain to hospital presentation and the coordination of care after the patient is released from the hospital.

Other limitations included the possibility of bias or misclassification from patient-reported race and ethnic identification, race-related bias related to disease severity scores, and missing data pertaining to whether the patient needed invasive mechanical ventilation or vasopressors after hospitalization.

Despite these limitations, the researchers believe this study shows how Black patients with sepsis and/or ARF might experience racial disparities that result in a longer length of hospitalization compared with White patients.

“Nevertheless, we identified disparities that appeared to persist despite adjustment for well-validated factors associated with disease severity and outcomes,” wrote the researchers. “These disparities likely have origins in patterns of systemic racism that pervade the lived American experience.”

Reference

Chesley CF, Chowdhury M, Small DS, et al. Racial Disparities in Length of Stay Among Severely Ill Patients Presenting With Sepsis and Acute Respiratory Failure. JAMA Netw Open. 2023;6(5):e239739. doi:10.1001/jamanetworkopen.2023.9739