Black-white racial disparities in sepsis: A prospective analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort

Justin Xavier Moore, John P. Donnelly, Russell Griffin, Monika M. Safford, George Howard, John Baddley, Henry E. Wang

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35 Scopus citations


Introduction: 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 %). Conclusion: 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.

Original languageEnglish
Article number279
JournalCritical Care
Issue number1
StatePublished - Jul 10 2015

Bibliographical note

Funding Information:
Dr Safford reports the following potential conflicts of interest: Amgen - salary support to study patterns of statin use in Medicare and other large databases; diaDexus - salary support for a research grant on lipids and CHD outcomes; diaDexus - consulting to help with FDA application; NIH, AHRQ - salary support for research grants. Mr Moore, Mr Donnelly and Drs, Griffin, Wang, Howard, and Baddley do not report any related conflicts of interest.

Funding Information:
This study was supported by award R01-NR012726 from the National Institute for Nursing Research, UL1-RR025777 from the National Center for Research Resources, and by grants from the Center for Clinical and Translational Science and the Lister Hill Center for Health Policy of the University of Alabama at Birmingham. The parent REGARDS study was supported by cooperative agreement U01-NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Representatives of the funding agencies have been involved in the review of the manuscript but not directly involved in the collection, management, analysis or interpretation of the data. The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at and Mr Donnelly received support from the Agency for Healthcare Research and Quality, Rockville, Maryland (T32-HS013852).

Publisher Copyright:
© 2015 Moore et al.

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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