The Center for Disease Control (CDC) estimates that one out of three hospital deaths can likely be attributed to sepsis during hospitalization, and that 87 percent of sepsis cases occurred outside the hospital. Literature has pointed to differences in health outcomes for sepsis patients based on race and ethnicity, finding higher mortality rates for patients of color or unspecified race/ethnicity when compared to White patients.
However, race as an independent factor is insufficient to explain the health disparities in sepsis outcomes. And despite standardizing a protocol-driven management for sepsis, a wide variability in mortality rates persists, which suggests the presence of healthcare inequity.
When it comes to diagnosing sepsis, it is believed that health equity plays a significant role in ensuring that individuals from all backgrounds receive timely and accurate diagnosis and treatment. Here’s how health equity can affect a sepsis diagnosis:
Awareness and Education
Adults without a high school diploma have more than two and a half times the risk of dying from sepsis as those with a doctorate. Efforts to promote health equity should include educating communities about sepsis and its signs, enabling people to recognize symptoms early and seek appropriate care.
Access to Healthcare Services
Disparities in access to healthcare, such as lack of insurance, limited availability of healthcare facilities, and geographic barriers, can often lead to delays in seeking medical attention for symptoms of sepsis.
Cultural Sensitivity
Differences in cultural beliefs and practices may influence how individuals perceive and respond to symptoms of sepsis.
Health Literacy
Limited English proficiency is associated with an 80 percent higher mortality risk among sepsis patients. Decreased health literacy can hinder the understanding of medical information, including sepsis symptoms and the need for urgent care.
Racial and Socioeconomic Disparities
People from marginalized racial and socioeconomic backgrounds often face barriers to accessing quality healthcare, leading to disparities in sepsis diagnosis and treatment. For example, infants from lower income families are 20 percent more likely to die from sepsis.
Diagnostic Bias
Health care providers should be vigilant to avoid overlooking sepsis symptoms in certain patient groups due to preconceived notions or biases.
Data Collection and Research
Future data collection and research should involve collecting and analyzing data to identify disparities in diagnosis rates, treatment outcomes, and access to care among different groups.
In summary, health equity is a crucial aspect of sepsis management. Health care organizations and communities should work together to promote health equity to help reduce disparities in sepsis care and improve overall patient outcomes.
References:
- Lizza BD, Betthauser KD, Juang PH, Hampton NB, Lyons PG, Kollef MH, et al. Racial disparities in readmissions following initial hospitalization for sepsis. Crit Care Med. 2021;49:e258–68.
- Prest J, Sathananthan M, Jeganathan N. Current Trends in Sepsis-Related Mortality in the United States. Crit Care Med. 2021;49:1276–84
- Linnander, E.L., Ayedun, A., Boatright, D. et al. Mitigating structural racism to reduce inequities in sepsis outcomes: a mixed methods, longitudinal intervention study. BMC Health Serv Res 22, 975 (2022). https://doi.org/10.1186/s12913-022-08331-5
- Nafiu, O. O., Mpody, C., Kim, S. S., Uffman, J. C. and Tobias, J. D. (2020) Race, Postoperative Complications, and Death in Apparently Healthy Children, Pediatrics, 146(2).
- Bohanon, F. J., Nunez Lopez, O., Adhikari, D., Mehta, H. B., Rojas-Khalil, Y., BowenJallow, K. A. and Radhakrishnan, R. S. (2017) Race, Income, and Insurance Status Affect Neonatal Sepsis Mortality and Healthcare Resource Utilization, Pediatric Infectious Disease Journal, 37(7), e178.
- Jacobs, Z. G., Prasad, P. A., Fang, M. C., Abe-Jones, Y. and Kangelaris, K. N. (2019) The Association between Limited English Proficiency and Sepsis Mortality, Journal of Hospital Medicine, 14, E1-E7.
