Racial differences in outcomes among patients with septic shock: A national cohort study

Table 1 Baseline characteristics of septic shock hospitalization, stratified by race/ethnicity, n (%)

Variables	NHW (n = 2391504)	NHB (n = 524535)	Hispanics (n = 405145)	Others (n = 260320)	P value
Age	67.69 ± 14.75	63.38 ± 15.39	62.58 ± 16.74	65.64 ± 16.37	< 0.001
Female	1130920 (47.3)	256595 (48.9)	182825 (45.1)	118395 (45.5)
Hospital bed size					0.0035
Small	450774 (18.8)	93780 (17.9)	71750 (17.7)	45055 (17.3)
Medium	689954 (28.9)	151535 (28.9)	124735 (30.8)	75240 (28.9)
Large	1250775 (52.3)	279220 (53.2)	208660 (51.5)	140025 (53.8)
Hospital teaching status					< 0.001
Rural	197030 (8.2)	22795 (4.3)	6850 (1.7)	8350 (3.2)
Urban non-teaching	506685 (21.2)	77955 (14.9)	89720 (22.1)	51625 (19.8)
Urban teaching	1687789 (70.6)	423785 (80.8)	308575 (76.2)	200345 (77.0)
Admission					< 0.001
Elective	102625 (4.3)	16710 (3.2)	14610 (3.6)	9960 (3.8)
Missing	3385 (0.1)	765 (0.1)	460 (0.1)	330 (0.1)
Primary payment coverage					< 0.001
Medicare	1609239 (67.3)	317860 (60.6)	206445 (51.0)	144475 (55.5)
Medicaid	252545 (10.6)	100525 (19.2)	97345 (24.0)	51335 (19.7)
Private insurance	403975 (16.9)	76220 (14.5)	65855 (16.3)	47415 (18.2)
Self-pay	55375 (2.3)	14470 (2.8)	23785 (5.9)	9115 (3.5)
No charge	4000 (0.2)	1100 (0.2)	1590 (0.4)	550 (0.2)
Other	63630 (2.7)	13530 (2.6)	9660 (2.4)	7080 (2.7)
Missing	2740 (0.1)	830 (0.2)	465 (0.1)	350 (0.1)
Median household income, $					< 0.001
1-28999	647215 (27.1)	266905 (50.9)	158690 (39.2)	63695 (24.5)
29000-35999	651700 (27.3)	110845 (21.1)	100835 (24.9)	53255 (20.5)
36000-46999	575325 (24.1)	82855 (15.8)	86380 (21.3)	61235 (23.5)
47000+	475645 (19.9)	54170 (10.3)	50045 (12.4)	74660 (28.7)
Missing	41620 (1.7)	9760 (1.9)	9195 (2.3)	7475 (2.9)
Hospital region					< 0.001
Northeast	431420 (18.0)	82520 (15.7)	51890 (12.8)	51375 (19.7)
Midwest	551250 (23.1)	100175 (19.1)	24830 (6.1)	25200 (9.7)
South	958410 (40.1)	288280 (55.0)	158370 (39.1)	66325 (25.5)
West	450424 (18.8)	53560 (10.2)	170055 (42.0)	117420 (45.1)
Comorbidities
Congestive heart failure	879550 (36.8)	205260 (39.1)	120295 (29.7)	84100 (32.3)	< 0.001
Cardiac arrhythmias	1036490 (43.3)	193560 (36.9)	133205 (32.9)	96575 (37.1)	< 0.001
Valvular heart diseases	225415 (9.4)	37995 (7.2)	25705 (6.3)	19340 (7.4)	< 0.001
Pulmonary circulatory disorders	233610 (9.8)	62480 (11.9)	33895 (8.4)	23065 (8.9)	< 0.001
Peripheral vascular disease	264480 (11.1)	54685 (10.4)	33775 (8.3)	23630 (9.1)	< 0.001
Hypertension	1497265 (62.6)	365370 (69.7)	247160 (61.0)	159030 (61.1)	< 0.001
Chronic lung disease	732830 (30.6)	124415 (23.7)	73185 (18.1)	53225 (20.4)	< 0.001
Diabetes	804655 (33.6)	221880 (42.3)	190655 (47.1)	109730 (42.2)	< 0.001
Chronic kidney disease	683580 (28.6)	215725 (41.1)	128585 (31.7)	81530 (31.3)	< 0.001
Liver disease	442915 (18.5)	97530 (18.6)	94405 (23.3)	56030 (21.5)	< 0.001
Anemia	170080 (7.1)	45145 (8.6)	30785 (7.6)	19385 (7.4)	< 0.001
AIDS	8715 (0.4)	14495 (2.8)	4640 (1.1)	1970 (0.8)	< 0.001
Cancer	333525 (13.9)	73540 (14.0)	49790 (12.3)	39595 (15.2)	< 0.001
Rheumatologic disorders	95845 (4.0)	20310 (3.9)	15035 (3.7)	8565 (3.3)	< 0.001
Coagulopathy	615690 (25.7)	151545 (28.9)	126840 (31.3)	81305 (31.2)	< 0.001
Obesity	410760 (17.2)	89985 (17.2)	76005 (18.8)	31645 (12.2)	< 0.001
Fluid and electrolyte disorders	1865804 (78.0)	424535 (80.9)	322810 (79.7)	207375 (79.7)	< 0.001
Alcohol abuse	184730 (7.7)	33290 (6.3)	33860 (8.4)	18570 (7.1)	< 0.001
Drug abuse	138285 (5.8)	27410 (5.2)	21515 (5.3)	10910 (4.2)	< 0.001
Depression	326810 (13.7)	42430 (8.1)	36215 (8.9)	19590 (7.5)	< 0.001
Smoking	328675 (13.7)	59840 (11.4)	30585 (7.5)	20615 (7.9)	< 0.001
Elixhauser comorbidity score	5.51 ± 2.20	5.82 ± 2.22	5.31 ± 2.21	5.33 ± 2.18	< 0.001

AIDS: Acquired immunodeficiency syndrome; NHB: Non-Hispanic Black; NHW: Non-Hispanic White.

Table 2 Univariate analysis of in-hospital outcomes, n (%)

Variables	NHW (n = 2391504)	NHB (n = 524535)	Hispanics (n = 405145)	Others (n = 260320)	P value
Mortality	771800 (32.3)	192865 (36.8)	143900 (35.5)	95335 (36.6)	< 0.001
Mechanical ventilation	1037710 (43.4)	283910 (54.1)	197920 (48.9)	129745 (49.8)	< 0.001
AKI	1618359 (67.7)	353470 (67.4)	258870 (63.9)	168670 (64.8)	< 0.001
AKI requiring dialysis	199885 (8.4)	64850 (12.4)	44320 (10.9)	25840 (9.9)	< 0.001
Cost of hospitalization	41384 ± 61342	52587 ± 75439	58786 ± 89798	60093 ± 94254	< 0.001
LOS	11.59 ± 13.73	15.04 ± 18.20	14.32 ± 18.02	13.86 ± 17.58	< 0.001

AKI: Acute kidney injury; NHB: Non-Hispanic Black; NHW: Non-Hispanic White; LOS: Length of stay.

Table 3 Adjusted in-hospital outcomes using multivariate logistic regression

Variables	NHB vs NHW1		Hispanics vs NHW2
	OR (95%CI)	P value	OR (95%CI)	P value
Mortality	1.24 (1.22-1.27)	< 0.001	1.14 (1.12-1.17)	< 0.001
Mechanical ventilation	1.45 (1.42-1.47)	< 0.001	1.13 (1.10-1.16)	< 0.001
AKI	0.94 (0.93-0.96)	< 0.001	0.76 (0.75-0.78)	< 0.001
AKI requiring dialysis	1.23 (1.19-1.26)	< 0.001	1.04 (1.01-1.08)	0.025

¹Adjusted for age, female, hospital teaching status, elective admission, insurance type, median household income, hospital region, congestive heart failure, hypertension, diabetes, anemia, cancer, chronic pulmonary disease, chronic kidney disease, human immunodeficiency virus (HIV), obesity, alcohol use, drug use, depression, smoking, chronic liver disease.

²Adjusted for age, female, hospital teaching status, hospital bed size, elective admission, insurance type, median household income, hospital region, congestive heart failure, hypertension, diabetes, anemia, cancer, chronic pulmonary disease, chronic kidney disease, chronic liver disease, HIV, obesity, alcohol use, drug use, depression, smoking. aOR: adjusted odds ratio; AKI: Acute kidney injury; NHB: Non-Hispanic Black; NHW: Non-Hispanic White. NHW as reference group.

Table 4 Race/ethnicity as a predictor of in-hospital mortality using multivariate logistic regression

Variables	Model 1		Model 2
	OR (95%CI)	P value	OR (95%CI)	P value
Race/Ethnicity
NHW	Ref		Ref
NHB	1.17 (1.15-1.19)	< 0.001	1.04 (1.02-1.06)	< 0.001
Hispanics	1.12 (1.09-1.14)	< 0.001	1.08 (1.06-1.11)	< 0.001
Others	1.14 (1.12-1.17)	< 0.001	1.07 (1.05-1.10)	< 0.001
Female	1.01 (1.00-1.02)	0.017	1.10 (1.09-1.12)	< 0.001
Elective	1.15 (1.12-1.19)	< 0.001	1.12 (1.08-1.16)	< 0.001
Hospital bed size
Small	Ref		Ref
Medium	1.09 (1.07-1.12)	< 0.001	1.05 (1.02-1.08)	< 0.001
Large	1.16 (1.13-1.18)	< 0.001	1.07 (1.04-1.09)	< 0.001
Hospital teaching status
Rural	Ref		Ref
Urban non-teaching	1.17 (1.13-1.21)	< 0.001	1.02 (0.98-1.06)	0.307
Urban teaching	1.30 (1.26-1.35)	< 0.001	1.08 (1.04-1.11)	< 0.001
Hospital region
Northeast	Ref		Ref
Midwest	0.76 (0.74-0.79)	< 0.001	0.77 (0.75-0.80)	< 0.001
South	0.86 (0.83-0.88)	< 0.001	0.87 (0.84-0.89)	< 0.001
West	0.85 (0.82-0.87)	< 0.001	0.87 (0.85-0.90)	< 0.001
Median household income
1-28999
29000-35999	0.93 (0.91-0.94)	< 0.001	0.94 (0.93-0.96)	< 0.001
36000-46999	0.91 (0.89-0.92)	< 0.001	0.94 (0.92-0.95)	< 0.001
47000+	0.86 (0.85-0.88)	< 0.001	0.91 (0.89-0.93)	< 0.001
Primary payment
Medicare	Ref		Ref
Medicaid	0.82 (0.80-0.83)	< 0.001	0.73 (0.71-0.74)	< 0.001
Private insurance	0.91 (0.89-0.92)	< 0.001	0.83 (0.82-0.85)	< 0.001
Self-pay	1.10 (1.06-1.14)	< 0.001	1.03 (0.99-1.07)	0.11
No charge	0.76 (0.66-0.87)	< 0.001	0.73 (0.64-0.83)	< 0.001
Other	1.32 (1.27-1.38)	< 0.001	1.35 (1.29-1.41)	< 0.001
Comorbidities
Congestive heart failure	1.02 (1.01-1.03)	0.001	0.97 (0.96-0.98)	< 0.001
Cardiac arrhythmias	1.37 (1.35-1.39)	< 0.001	1.28 (1.27-1.30)	< 0.001
Pulmonary circulatory disorders	1.16 (1.14-1.18)	< 0.001	1.11 (1.08-1.13)	< 0.001
Peripheral vascular disease	1.20 (1.17-1.22)	< 0.001	1.27 (1.24-1.29)	< 0.001
Chronic lung disease	1.04 (1.02-1.05)	< 0.001	0.95 (0.94-0.96)	< 0.001
CKD	1.07 (1.06-1.09)	< 0.001	1.11 (1.09-1.12)	< 0.001
Liver disease	2.07 (2.04-2.10)	< 0.001	1.82 (1.80-1.85)	< 0.001
Rheumatologic disorders	0.95 (0.92-0.97)	< 0.001	1.00 (0.97-1.03)	0.879
Coagulopathy	1.35 (1.33-1.37)	< 0.001	1.22 (1.20-1.23)	< 0.001
Obesity	0.86 (0.85-0.88)	< 0.001	0.77 (0.76-0.79)	< 0.001
Fluid and electrolyte disorders	1.33 (1.31-1.35)	< 0.001	1.05 (1.03-1.07)	< 0.001
Alcohol abuse	0.93 (0.91-0.95)	< 0.001	0.89 (0.87-0.91)	< 0.001
Drug abuse	0.70 (0.69-0.72)	< 0.001	0.74 (0.72-0.75)	< 0.001
Depression	0.63 (0.61-0.64)	< 0.001	0.57 (0.56-0.59)	< 0.001
Hypertension	0.96 (0.95-0.97)	< 0.001	1.00 (0.98-1.01)	0.717
Anemia	0.68 (0.66-0.69)	< 0.001	0.71 (0.70-0.73)	< 0.001
Cancer	1.45 (1.43-1.47)	< 0.001	1.73 (1.70-1.76)	< 0.001
Diabetes	0.94 (0.93-0.95)	< 0.001	0.93 (0.91-0.94)	< 0.001
Smoking	0.78 (0.77-0.80)	< 0.001	0.77 (0.76-0.79)	< 0.001
AKI	-	-	1.34 (1.32-1.36)	< 0.001
AKI requiring dialysis	-	-	1.37 (1.34-1.40)	< 0.001
Mechanical ventilation	-	-	3.90 (3.85-3.95)	< 0.001

AKI: Acute kidney injury; NHB: Non-Hispanic Black; NHW: Non-Hispanic White; CKD: Chronic kidney disease; Ref: Reference.