Racial differences in outcomes among patients with septic shock: A national cohort study

BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality, particularly in critical care. While racial differences in sepsis incidence are documented, the impact of race on sepsis outcomes remains inconsistent. AIM To evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock, focusing on in-hospital mortality, length of stay (LOS), and hospitalization costs. METHODS We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021. Patients diagnosed with septic shock were identified using ICD-10 code R65.21. The primary outcome was in-hospital mortality; secondary outcomes included trends in septic shock hospitalizations, mortality, length of stay, and cost of hospitalizations. RESULTS Among 3581504 hospitalizations for septic shock, the racial distribution was 67% Non-Hispanic White (NHW), 15% Non-Hispanic Black (NHB), 11% Hispanic, and 7% other groups, with a mean age of 66.3 years. In-hospital mortality was 33.6%, highest among other racial groups (36.7%). Mortality was stable across racial groups from 2016–2019 but rose sharply in 2020–2021, especially among Hispanic patients. Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients. NHB patients had the longest LOS, while other racial groups incurred the highest cost of hospitalizations. CONCLUSION We found higher mortality among NHB, Hispanic, and other racial groups in septic shock patients, likely driven by higher risk of in-hospital complications among these racial groups. This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.