title: Black-white racial disparities in sepsis: a prospective analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort.
abstract: BACKGROUND
  Sepsis is a major public health problem. Prior studies using hospital-based data describe higher rates of sepsis among black than whites participants. We sought to characterize racial differences in incident sepsis in a large cohort of adult community-dwelling adults.
  
  
  METHODS
  We analyzed data on 29,690 participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We determined the associations between race and first-infection and first-sepsis events, adjusted for participant sociodemographics, health behaviors, chronic medical conditions and biomarkers. We also determined the association between race and first-sepsis events limited to first-infection events. We contrasted participant characteristics and hospital course between black and white sepsis hospitalizations.
  
  
  RESULTS
  Among eligible REGARDS participants there were 12,216 (41.1%) black and 17,474 (58.9%) white participants. There were 2,600 first-infection events; the incidence of first-infection events was lower for black participants than for white participants (12.10 vs. 15.76 per 1,000 person-years; adjusted HR 0.65; 95% CI, 0.59-0.71). There were 1,526 first-sepsis events; the incidence of first-sepsis events was lower for black participants than for white participants (6.93 vs. 9.10 per 1,000 person-years, adjusted HR 0.64; 95% CI, 0.57-0.72). When limited to first-infection events, the odds of sepsis were similar between black and white participants (adjusted OR 1.01; 95% CI, 0.84-1.21). Among first-sepsis events, black participants were more likely to be diagnosed with severe sepsis (76.9% vs. 71.5%).
  
  
  CONCLUSIONS
  In the REGARDS cohort, black participants were less likely than white participants to experience infection and sepsis events. Further efforts should focus on elucidating the underlying reasons for these observations, which are in contrast to existing literature.
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, 619 19th Street South, OHB 251, Birmingham, AL, 35249, USA. jxmoore@uab.edu.|Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. jxmoore@uab.edu.
authors.forename: Justin Xavier
authors.initials: JX
authors.lastname: Moore
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, 619 19th Street South, OHB 251, Birmingham, AL, 35249, USA. johndonnelly@uabmc.edu.|Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. johndonnelly@uabmc.edu.|Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA. johndonnelly@uabmc.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Donnelly
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. russellg@uab.edu.
authors.forename: Russell
authors.initials: R
authors.lastname: Griffin
authors.affiliation: Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA. msafford@uabmc.edu.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA. ghoward@uab.edu.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA. jbaddley@uab.edu.
authors.forename: John
authors.initials: J
authors.lastname: Baddley
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, 619 19th Street South, OHB 251, Birmingham, AL, 35249, USA. hwang@uabmc.edu.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology*; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American