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Blacks are at a higher risk than whites for developing infections and organ injury that can cause severe sepsis, a new study suggests.

Severe sepsis, a life-threatening blood infection, occurs when an initial bacterial infection overwhelms the body’s immune system, causing blood clots to form and block blood flow to organs. This can lead to organ failure and death.

Though the researchers at the University of Pittsburgh have known for sometime that black patients are more likely to develop severe sepsis over white patients, they were uncertain whether these disparities were caused by differences in susceptibility to infection rates or in the risk of developing organ dysfunction once infection has occurred, said Dr. Florian B. Mayr, lead author of the study.

After examining data from hospitals in seven states and data on infection-related hospital visits, researchers found that both factors contribute to the higher rate of severe sepsis.

The study shows that blacks, compared to whites, had a 67 percent higher rate of severe sepsis and 80 percent higher mortality. Infection rates were 47 blacks and 34 whites per 1,000 people, and organ dysfunction rates were 29 percent higher in blacks than whites.

These findings are an important step in developing interventions to reduce these disparities, Mayr said.

“Many people know about heart attacks and kidney disease, but very few people actually know what severe sepsis is or what causes it,” he said. “I think education of the general population is important.”

Severe sepsis affects 750,000 people a year, and one in four people who develop the illness will die from it.

Mayr said individuals, communities, health care providers and policymakers all share the responsibility of reducing the disparities. Individuals must regularly receive the proper vaccinations, while health care providers must ensure access to quality care since severe sepsis rates are higher in hospitals that predominantly serve blacks, he said.

The study also found that racial disparities were the largest among younger adults.
“We were stunned by that finding,” Mayr said. “We do not have a good explanation for that so far.”

The researchers are now working on identifying reasons for the findings of this study. Mayr said both biological and socioeconomic differences could contribute to the disparities.

“I’m certain we have to improve and expand our work on understanding social variables,” he said. “But on the other end, we’re interested in looking into the biological explanations and if there are differences in response to infection. We have to consider every piece.”

Photo by Steve Savage

The heart is colorblind. Interracial couples have known it for millennia. But a new study of heart transplants confirms that transplant recipients can expect similar outcomes whether the donor and recipient were race-matched or were interracial.

The study, conducted by researchers at Johns Hopkins University, examined medical records from over 20,000 transplant patients identified as black, white, Hispanic or Asian and found that survival rates were the same for race-matched and mismatched donors up to one year after the procedure.

This evidence suggests that donor–recipient race matching will not improve transplant success in the short term, but it fails to explain long term differences in survival of African-American transplant recipients. Five years after heart transplant surgery African-American patients have a survival rate of 65% compared with nearly 72% for Hispanics and 75% for whites.

The same gap exists when patients were followed for 10 years after a heart transplant. The likelihood that an African-American transplant recipient will survive for 10 years after surgery is 10.8% and 11.4% lower than rates seen in Hispanics and whites respectively.

While race-matching was ruled out as a root cause for short-term survival differences, other factors including health insurance, education, hypertension, gender mismatch and donor tissue antigen mismatch may play a role.

Great article on health disparities at Newsweek.com

http://www.newsweek.com/2010/02/14/the-great-divide.html

For more info see:

http://www.fiercehealthcare.com/story/race-matching-moot-heart-transplant-patients/2010-06-01

Image: Corbis

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