A large, representative study of pediatric sepsis found evidence of outcome disparities according to race or ethnicity and insurance status. The results of this population-based, retrospective cohort study were published in The Lancet Child & Adolescent Health.
Investigators used data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) to identify 12,297 children aged 0 to 21 years with severe sepsis with or without shock that were admitted to a hospital in 2016.
The final cohort was reduced to 9816 children due to missing data on race or ethnicity, missing data on insurance status, and some patients being transferred out of hospital. Of these, 5385 (54.9%) were publicly insured and associations between race or ethnicity and socioeconomic position were observed. More White children were privately insured and fewer lived in zip codes with the lowest quartile median income compared with Black or Hispanic children. While the overall prevalence of chronic complex conditions was high in the cohort, these conditions occurred in a higher proportion of Black and Hispanic children compared to White children.
Results found that increased mortality was more associated with Black race or ethnicity compared to White ethnicity (adjusted odds ratio [aOR], 1.19; 95% CI, 1.02-1.38; P =.028), while Hispanic kids had similar odds of death compared to White children. There were no associations between insurance status and mortality. However, other insurance statuses, such as self-pay or no charge, was associated with increased mortality (aOR 1.30; 95% CI, 1.04-1.61; P =.021).
The difference in mortality among Black children was driven by Black mortality in the southern (adjusted OR 1.30; 95% CI, 1.04-1.62; P =.019) and western United States (aOR 1.58; 95% CI, 1.05-2.38; P =.027). Children with chronic complex conditions had 7 times increased odds of death (OR 7.21; 95% CI, 5.92-8.80; P <.0001) compared with children without these conditions.
Longer hospital stays were observed for Black (adjusted hazard ratio [aHR], 0.88; 95% CI, 0.82-0.94; P =.0002) and Hispanic (aHR, 0.94; 95% CI, 0.88-1.00; P =.049) kids compared to White kids. This was especially true for Black neonates, who had a reduced probability of being discharged from the hospital by day 30 (aHR, 0.53; 95% CI, 0.36-0.77; P =.0011). There was no evidence of interactions between race or ethnicity and insurance status (P =.32) and median household income by zip code (P =.16).
Important limitations to the dataset were that KID provides race and ethnicity as an aggregate variable so the separate effects of Hispanic ethnicity from race could not be examined, said investigators.
“[D]isparate outcomes exist in childhood sepsis based on race or ethnicity and insurance status, with evidence of significantly worse outcomes for children of colour in the south and west” of the United States, the investigators concluded.
Mitchell HK, Reddy A, Montoya-Williams D, Harhay M, Fowler JC, Yehya N. Hospital outcomes for children with severe sepsis in the USA by race or ethnicity and insurance status: a population-based, retrospective cohort study. Lancet Child Adolesc Health. Published online December 14, 2020. doi: 10.1016/S2352-4642(20)30341-2.