Gender and Racial Disparities in Outcomes and Healthcare Resource Utilization in Necrotizing Fasciitis

Author(s):
Amir Sohail; Mohammed Quazi; Abu baker Sheikh

Background:

Necrotizing fasciitis is a rapidly progressive infection associated with high mortality and complications. There is paucity of high-quality data on disparities in clinical outcomes of necrotizing fasciitis. Our study aims to identify gender and racial disparities in necrotizing fasciitis outcomes.

Hypothesis:

We hypothesized that women and racial minorities have less favourable outcomes with necrotizing fascitis.

Methods:

We used data from the Nationwide Inpatient Sample from 2016-2020. Chi-Square test and t-test were used to test for associations between categorical and continuous variables, as appropriate. Multivariate logistic regression models were used to obtain odds ratio for in-hospital mortality and various complications. For continuous outcome variables, multivariate linear regression models were created.

Results:

Among 118,775 patients with necrotizing fasciitis, women (adjusted odds ratio [aOR] 1.20, 95% confidence interval [CI]: 1.2-1.3, p=0.001), and Asian (aOR 1.50 (95% CI:1.1-2, p=0.01) and Hispanic (aOR:1.00;95% CI:1.0-1.4; p=0.045) patients had a significantly higher in-hospital mortality as compared to White patients.

In comparison with men, women were more likely to require invasive mechanical ventilation and blood transfusions, and develop ARDS. They were less  likely to develop AKI, acute myocardial infarction, venous thromboembolism and require non-invasive mechanical ventilation (p<0.05 for all). Similarly, certain racial minority groups were at a higher risk for complications, such as AKI requiring hemodialysis, ARDS, venous thromboembolism, sudden cardiac arrest, and need for blood transfusion, among others (p< 0.05 for all).

As compared to white patients, African American (1.7 days longer, p< 0.001), Asian (4.3 days longer, p< 0.001), and Hispanic (0.6 days longer, p = 0.048) patients had significantly longer length of stay. Asian, African American, and Hispanic patients had significantly higher hospitalization costs, amounting to an additional $17,596.1(p<0.001), $5,899.6(p<0.001), and $4,356.6(p<0.01), respectively, versus White patients.

Conclusions:

Females and racial minorities are at increased risk of mortality and higher healthcare resource utilization in necrotizing fasciitis. There is a need for development of equitable management strategies to effectively address these disparities.