McGowan Institute for Regenerative Medicine
affiliated faculty member Derek Angus, MD, MPH, FRCP, FCCM, FCCP (pictured), professor in Critical Care Medicine as well as Health Policy and Management at the University of Pittsburgh and vice chair for research in the Department of Critical Care, and researchers at the University of Pittsburgh School of Medicine say black people are at greater risk than whites for severe sepsis, a condition where overwhelming infection can lead to deadly consequences, because blacks are both more susceptible to getting infections and more likely to develop organ injuries.
The study also suggests that both community- and hospital-based interventions could help alleviate such racial disparities, said lead author Florian B. Mayr, MD, MPH, research fellow, Department of Critical Care Medicine, University of Pittsburgh. For example, immunization guidelines could be modified to encourage administration of pneumococcal vaccine to younger black people to prevent some lung infections. Narrowing quality gaps across hospitals in the care of patients who are hospitalized for an infection also could reduce racial disparities in severe sepsis.
Annually, more than 750,000 Americans develop severe sepsis, defined as systemic infection plus organ injury, and 1 out of every 4 individuals who develop it will die during their hospital stay. The researchers examined 2005 discharge data from hospitals in Arizona, Florida, Massachusetts, Maryland, New Jersey, New York, and Texas, representing a quarter of the American population, as well as infection-related emergency department visits data from the 2003-2007 National Hospital Ambulatory Care Survey.
After controlling for age and sex, they found that compared to whites, blacks had a 67 percent higher rate of severe sepsis, and 80 percent higher mortality. That greater likelihood was explained by an infection rate that was 47 blacks and 34 whites per 1,000 people, and the odds of a black person developing acute organ dysfunction was 29 percent higher than whites.
As an example of how a community-based intervention could reduce such disparities, the researchers calculated the potential impact of modifying vaccination guidelines to prevent pneumonia caused by Strep pneumonia or pneumococcus, which can progress to a systemic infection and subsequent organ injury. Currently, pneumococcal vaccination is recommended for people 65 and older, younger adults with certain chronic illnesses, and small children.
Racial disparities in severe sepsis are likely due to socio-economic and other factors. Community-based interventions, such as better management of chronic disease, as well as hospital-based approaches, must be part of an overall strategy to address this problem, Sachin Yende, MD, MS, assistant professor of critical care medicine, University of Pittsburgh, and the study’s corresponding author, added.
The researchers are now working on identifying biologic differences that might also contribute to differences in susceptibility to infection and risk for organ dysfunction.
Illustration: McGowan Institute for Regenerative Medicine.
University of Pittsburgh Schools of the Health Sciences Media Relations News Release (06/22/10)
Bloomberg Businessweek (06/22/10)
MedPage Today (06/22/10)
WDUQ News Blog (06/22/10)
Pittsburgh Tribune-Review (06/23/10)
Bio: Dr. Derek Angus
Abstract (The Journal of the American Medical Association, Vol. 303 No. 24, June 23/30, 2010)