Investigating Racial and Socioeconomic Characteristics in Pediatric Sepsis Using Electronic Health Data.
Journal
Hospital pediatrics
ISSN: 2154-1671
Titre abrégé: Hosp Pediatr
Pays: United States
ID NLM: 101585349
Informations de publication
Date de publication:
01 02 2023
01 02 2023
Historique:
pubmed:
25
1
2023
medline:
3
2
2023
entrez:
24
1
2023
Statut:
ppublish
Résumé
Racial/ethnic and socioeconomic disparities are reported in sepsis, with increased mortality for minority and low socioeconomic status groups; however, these studies rely on billing codes that are imprecise in identifying sepsis. Using a previously validated algorithm to detect pediatric sepsis using electronic clinical data, we hypothesized that racial/ethnic and socioeconomic status disparities would be evident in this group. We performed a retrospective study from a large, quaternary academic center, including sepsis episodes from January 20, 2011, to May 20, 2021, identified by an algorithm indicative of bacterial infection with organ dysfunction (cardiac, respiratory, renal, or hematologic). Multivariable logistic regression was used to measure association of race/ethnicity, insurance status, and social disorganization index, with the primary outcome of mortality, adjusting for age, sex, complex chronic conditions, organ dysfunction on day 1, source of admission, and time to hospital. Secondary outcomes were ICU admission, readmission, organ dysfunction-free days, and sepsis therapies. Among 4532 patient episodes, the mortality rate was 9.7%. There was no difference in adjusted odds of mortality on the basis of race/ethnicity, insurance status, or social disorganization. There was no significant association between our predictors and ICU admission. Hispanic patients and publicly insured patients were more likely to be readmitted within 1 year (Hispanic odds ratio 1.28 [1.06-1.5]; public odds ratio 1.19 [1.05-1.35]). Previously described disparities were not observed when using electronic clinical data to identify sepsis; however, data were only single center. There were significantly higher readmissions in patients who were publicly insured or identified as Hispanic or Latino, which require further investigation.
Sections du résumé
BACKGROUND AND OBJECTIVES
Racial/ethnic and socioeconomic disparities are reported in sepsis, with increased mortality for minority and low socioeconomic status groups; however, these studies rely on billing codes that are imprecise in identifying sepsis. Using a previously validated algorithm to detect pediatric sepsis using electronic clinical data, we hypothesized that racial/ethnic and socioeconomic status disparities would be evident in this group.
METHODS
We performed a retrospective study from a large, quaternary academic center, including sepsis episodes from January 20, 2011, to May 20, 2021, identified by an algorithm indicative of bacterial infection with organ dysfunction (cardiac, respiratory, renal, or hematologic). Multivariable logistic regression was used to measure association of race/ethnicity, insurance status, and social disorganization index, with the primary outcome of mortality, adjusting for age, sex, complex chronic conditions, organ dysfunction on day 1, source of admission, and time to hospital. Secondary outcomes were ICU admission, readmission, organ dysfunction-free days, and sepsis therapies.
RESULTS
Among 4532 patient episodes, the mortality rate was 9.7%. There was no difference in adjusted odds of mortality on the basis of race/ethnicity, insurance status, or social disorganization. There was no significant association between our predictors and ICU admission. Hispanic patients and publicly insured patients were more likely to be readmitted within 1 year (Hispanic odds ratio 1.28 [1.06-1.5]; public odds ratio 1.19 [1.05-1.35]).
CONCLUSIONS
Previously described disparities were not observed when using electronic clinical data to identify sepsis; however, data were only single center. There were significantly higher readmissions in patients who were publicly insured or identified as Hispanic or Latino, which require further investigation.
Identifiants
pubmed: 36691761
pii: 190502
doi: 10.1542/hpeds.2022-006752
pmc: PMC10680400
mid: NIHMS1935227
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
138-146Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL098054
Pays : United States
Informations de copyright
Copyright © 2023 by the American Academy of Pediatrics.
Références
Am J Respir Crit Care Med. 2008 Feb 1;177(3):279-84
pubmed: 17975201
Crit Care Med. 2013 Jul;41(7):1761-73
pubmed: 23685639
Lancet Child Adolesc Health. 2021 Feb;5(2):103-112
pubmed: 33333071
Am J Public Health. 2011 Dec;101 Suppl 1:S149-55
pubmed: 21551385
Pediatr Crit Care Med. 2017 Aug;18(8):805-806
pubmed: 28796706
JAMA. 2011 Feb 16;305(7):682-90
pubmed: 21325184
Pediatrics. 2009 Mar;123(3):849-57
pubmed: 19255013
J Gen Intern Med. 2015 Jun;30(6):783-9
pubmed: 25666220
Health Place. 2020 Sep;65:102383
pubmed: 32823141
Pediatr Crit Care Med. 2020 Feb;21(2):113-121
pubmed: 32032262
Health Place. 2017 Jan;43:151-157
pubmed: 28061392
JAMA Pediatr. 2017 Oct 2;171(10):e172352
pubmed: 28783810
J Pediatr Intensive Care. 2020 Dec 26;11(2):147-152
pubmed: 35734203
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Pediatr Crit Care Med. 2012 Jul;13(4):e219-26
pubmed: 22460773
J Crit Care. 2018 Aug;46:134-138
pubmed: 29929704
Intensive Care Med. 2018 Feb;44(2):179-188
pubmed: 29256116
Pediatr Infect Dis J. 2018 Jul;37(7):e178-e184
pubmed: 29189608
JAMA. 2010 Jun 23;303(24):2495-503
pubmed: 20571016
J Crit Care. 2018 Aug;46:129-133
pubmed: 29370964
Pediatr Crit Care Med. 2013 Sep;14(7):686-93
pubmed: 23897242
Pediatr Crit Care Med. 2017 Aug;18(8):758-763
pubmed: 28492402
Hosp Pediatr. 2017 Jan;7(1):1-8
pubmed: 27923838
Arch Pediatr Adolesc Med. 2011 Nov;165(11):1020-6
pubmed: 22065182
J Hosp Med. 2010 May-Jun;5(5):276-82
pubmed: 20533573
Pediatr Infect Dis J. 2011 Nov;30(11):937-41
pubmed: 21654548
JAMA. 2017 Oct 3;318(13):1241-1249
pubmed: 28903154
Pediatrics. 2011 Jun;127(6):e1505-12
pubmed: 21555493
J Pediatr. 2015 Dec;167(6):1295-300.e4
pubmed: 26470685
J Pediatr. 2014 Feb;164(2):300-5
pubmed: 24238863
Pediatrics. 2010 Oct;126(4):647-55
pubmed: 20855394
N Engl J Med. 2003 Apr 17;348(16):1546-54
pubmed: 12700374
Pediatr Crit Care Med. 2014 Nov;15(9):828-38
pubmed: 25226500
Pediatr Cardiol. 2021 Mar;42(3):643-653
pubmed: 33533966
Crit Care. 2015 Sep 16;19:325
pubmed: 26373923
BMC Pediatr. 2014 Aug 08;14:199
pubmed: 25102958
Psychol Bull. 2000 Mar;126(2):309-37
pubmed: 10748645
Crit Care. 2009;13(1):R28
pubmed: 19250547
Pediatr Crit Care Med. 2014 Nov;15(9):798-805
pubmed: 25162514
Psychosom Med. 2004 Jul-Aug;66(4):553-8
pubmed: 15272102