TUESDAY, June 22 (HealthDay News) -- Black patients are more
likely to develop the life-threatening blood infection sepsis and
have a greater chance of dying from it than whites, new research
suggests.
In severe sepsis, a bacterial or fungal infection overwhelms the
body's immune system, causing a disruption of normal processes in
the blood. When this occurs, small blood clots form, blocking blood
flow to the organs, which can lead to organ damage, organ failure
and death.
Researchers from the University of Pittsburgh examined hospital
discharge data from seven states in 2005 and emergency department
visits during a five-year period between 2003-2007 from the
National Hospital Ambulatory Care Survey. Of 8.6 million
hospitalizations for reasons other than childbirth, they identified
more than 2.2 million cases of infections. Of those, nearly 17
percent, or about 380,000, also involved organ dysfunction, a
hallmark of severe sepsis.
The investigators found that black patients had a higher risk of
being hospitalized for an infection than white patients. About 47
per 1,000 blacks were hospitalized due to infection, compared to 34
per 1,000 whites.
The greater incidence of infections translated into a higher
risk for sepsis. Black patients had a 67 percent higher severe
sepsis hospitalization rate than non-Hispanic whites -- the
incidence was about 9.4 per 1,000 blacks compared to 5.6 per 1,000
whites.
Because blacks were both more likely to be hospitalized for an
infection, and because severe sepsis occurred more frequently among
blacks, black patients were 80 percent more likely to die from it,
according to the study published in the June 23/30 issue of the
Journal of the American Medical Association.
Severe sepsis sickens about 750,000 people in the United States
each year. About 28 percent of those who develop severe sepsis die,
according to estimates cited in the study. Previous research has
shown that people who have chronic medical conditions are more
prone to sepsis.
In the current research, about 24 percent of blacks who were
hospitalized for infection had diabetes and 3.5 percent had chronic
kidney disease, compared to roughly 18 percent and 2.6 percent for
whites, respectively.
To combat sepsis, the study authors recommended steps to reduce
the infections that trigger sepsis in the first place.
The most common infections among those with sepsis were
respiratory infections, such as bacterial pneumonia, which
accounted for about one-third of cases in the study. Other common
sepsis-inducing infections included urinary tract, abdominal,
wounds and soft tissue infections.
Current recommendations call for those aged 65 and older or
those under 65 with chronic conditions such as diabetes to receive
a pneumococcal vaccination. But to reduce the risk of sepsis in
blacks, it's possible vaccine recommendations should be revised to
encourage younger blacks to get vaccinated, the researchers
noted.
Black patients hospitalized for infections tended to be younger
than whites. The average age for blacks with severe sepsis was 62,
compared to 70 for whites, the research showed.
The same was true for pneumonia, with about 45 percent of whites
who developed pneumonia under the age of 65, compared to about 74
percent of blacks.
Further analysis showed that if everyone was vaccinated
according to the current guidelines, the vaccine would miss about
25 percent of blacks who develop pneumonia compared to only 13
percent of whites.
Better care for chronic diseases such as diabetes and kidney
disease may also help ward off infections that lead to sepsis, the
study authors suggested.
"People who tend to develop infections more often have diabetes and chronic kidney disease, and studies have shown blacks are more likely to have these chronic conditions earlier in life," said study co-author Dr. Sachin Yende, an assistant professor of critical care medicine at University of Pittsburgh. "The answer to reducing racial discrepancies in severe sepsis will require strategies in multiple areas: vaccination changes and improved management of chronic conditions such as diabetes and kidney disease."
Researchers could not say to what degree socioeconomic factors
might lead to higher incidence of infection and sepsis in blacks.
In addition, it's possible there are biological differences in how
blacks and whites respond to infections that make blacks more
likely to develop sepsis, the researchers noted.
Dr. Omar Lateef, director of the medical intensive care unit at
Rush University Medical Center, said the risk of sepsis, especially
among those with chronic conditions, should be taken very
seriously. Even those who survive severe sepsis "can have a very
long, drawn-out course of recovery. It's a huge stress for your
body, and some people may never fully recover," Lateef said.
The reasons why chronic conditions such as diabetes raise the
risk aren't fully understood, Lateef said. But patients can help
protect themselves from sepsis, he added.
"You have to take care of yourself, get your vaccines up to date, take all your medicines and regularly check in with your primary care physician," Lateef suggested.
For doctors, "doing a better job with outpatients is going to be
the best thing they can do to improve mortality in the inpatient
population," Lateef said.
More information
The
Society of Critical Care Medicine has more on
sepsis.