Ang SP, Chia JE, Iglesias J. Racial differences in outcomes among patients with septic shock: A national cohort study. World J Crit Care Med 2025; 14(3): 106387 [DOI: 10.5492/wjccm.v14.i3.106387]
Corresponding Author of This Article
Jose Iglesias, FACP, FASN, Associate Professor, Department of Critical Care, Community Medical Center, 99 W Rt 37, Toms River, NJ 08757, United States. jiglesias23@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Sep 9, 2025; 14(3): 106387 Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.106387
Racial differences in outcomes among patients with septic shock: A national cohort study
Song-Peng Ang, Jia-Ee Chia, Jose Iglesias
Song-Peng Ang, Department of Internal Medicine, Rutgers The State University of New Jersey, Toms River, NJ 08755, United States
Jia-Ee Chia, Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79912, United States
Jose Iglesias, Department of Critical Care, Community Medical Center, Toms River, NJ 08757, United States
Jose Iglesias, Department of Nephrology, Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
Jose Iglesias, Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
Co-first authors: Song-Peng Ang and Jia-Ee Chia.
Author contributions: Ang SP and Iglesias J conceptualize and designed the study; Ang SP and Iglesias J were involved in writing and reviewing the manuscript; Chia JE performed data acquisition, analysis, interpretation and visualization; Iglesias J supervised the study; All authors provided final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.
Institutional review board statement: Given the use of this deidentified, limited dataset, ethical approval or institutional review board approval is not required according to HCUP data use agreement.
Informed consent statement: The NIS dataset does not include direct patient identifiers and adheres strictly to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Given the use of deidentified dataset, informed consent is not required. However, all analyses were conducted in accordance with ethical research principles, institutional guidelines, and the HCUP Data Use Agreement to ensure the protection of patient confidentiality.
Conflict-of-interest statement: All authors declare that they have no competing interests.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jose Iglesias, FACP, FASN, Associate Professor, Department of Critical Care, Community Medical Center, 99 W Rt 37, Toms River, NJ 08757, United States. jiglesias23@gmail.com
Received: February 24, 2025 Revised: April 3, 2025 Accepted: May 7, 2025 Published online: September 9, 2025 Processing time: 144 Days and 7.5 Hours
Abstract
BACKGROUND
Sepsis and septic shock pose critical public health challenges with high mortality, particularly in critical care. While racial differences in sepsis incidence are documented, the impact of race on sepsis outcomes remains inconsistent.
AIM
To evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock, focusing on in-hospital mortality, length of stay (LOS), and hospitalization costs.
METHODS
We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021. Patients diagnosed with septic shock were identified using ICD-10 code R65.21. The primary outcome was in-hospital mortality; secondary outcomes included trends in septic shock hospitalizations, mortality, length of stay, and cost of hospitalizations.
RESULTS
Among 3581504 hospitalizations for septic shock, the racial distribution was 67% Non-Hispanic White (NHW), 15% Non-Hispanic Black (NHB), 11% Hispanic, and 7% other groups, with a mean age of 66.3 years. In-hospital mortality was 33.6%, highest among other racial groups (36.7%). Mortality was stable across racial groups from 2016–2019 but rose sharply in 2020–2021, especially among Hispanic patients. Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients. NHB patients had the longest LOS, while other racial groups incurred the highest cost of hospitalizations.
CONCLUSION
We found higher mortality among NHB, Hispanic, and other racial groups in septic shock patients, likely driven by higher risk of in-hospital complications among these racial groups. This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.
Core Tip: Non-Hispanic Black (NHB) and Hispanic patients faced higher adjusted in-hospital mortality compared to Non-Hispanic White patients, primarily driven by higher incidence of in-hospital complications. Mortality increased sharply during 2020–2021, particularly among Hispanic patients. NHB patients had the longest hospital stays, while "Other" racial groups incurred the highest costs. Structural inequities in healthcare access and pandemic-related stressors likely contributed to worsening outcomes in marginalized groups, emphasizing the need for targeted interventions.
