Experts know that there are racial disparities in the frequency of severe sepsis, a condition in which people develop severe infections accompanied by organ dysfunction. But they are still working to understand why such differences exist and the best strategies to use to minimize them.

According to the results of a study conducted by researchers at the University of Pittsburgh School of Medicine, black patients have a greater incidence of severe sepsis than white patients -- and that is due to both higher rates of infections and a higher risk of conditions that lead to organ failure.

The study is being praised by experts who call the study an important step in better understanding the disparity, but many also believe more detailed research will lead to possible solutions.

Jeannette South-Paul, professor and chair of the department of family medicine at Pitt, said that researchers should investigate behavioral health factors in addition to physical health.

"We now know there's an increasing body of evidence that social circumstances and behaviors of individuals in social circumstances dramatically influence their risk for disease," she said.

In the latest study, published in this week's Journal of the American Medical Association, black patients had a 67 percent higher severe sepsis hospitalization rate than white patients.

Severe sepsis affects more than 750,000 U.S. residents each year, and 28 percent of individuals who develop it will die. In this study, black patients had an 80 percent higher risk of dying from it than white patients.

Researchers found that the risk of organ injury among African Americans was 29 percent higher, said Sachin Yende, assistant professor of critical care medicine, University of Pittsburgh, and one of the study's lead authors. Organ injury means that at least one organ system is not working properly. For example, a patient's lungs may stop working right and the patient may go into acute respiratory failure.

Researchers also found that the risk of infection among blacks was 40 percent higher than the risk of infection among whites. A number of infections can cause sepsis, including pneumonia, urinary tract infections and meningitis.

The study included analysis of infection-related hospitalizations from the 2005 hospital discharge data of seven U.S. states and infection-related emergency department visits from the 2003-07 National Hospital Ambulatory Care Survey.

But there are limits to using discharge data, experts said.

The data simply does not contain the kind of "detailed information that you'd be able to collect at the bedside," said Greg Martin, associate professor of medicine at Emory University.

A whole host of factors -- socioeconomic status, education level, cultural beliefs, genetics and comorbidity, or how many different chronic diseases a patient has -- may be playing a role in the disparity, Dr. Martin said. By conducting a study in which patients are interviewed, researchers would be able to consider more factors and so gain a better idea of what kinds of strategies to implement to close the gap, he said.

In the JAMA report, the researchers proposed both hospital-based and community-based interventions.

Better resuscitation strategies in hospitals, including early identification of patients and administering of fluids as well as prompt delivery of the correct antibiotic, may reduce the organ dysfunction rate, Dr. Yende said.

Interventions should especially target hospitals that serve large proportions of black patients, according to the study. Quality of care varies from hospital to hospital, and blacks may tend to receive care at hospitals that provide lower quality of care, Dr. Yende said. In general, there seems to be no difference in the quality of care for black and white patients at the same hospital, he said.

Dr. Martin said that researchers still don't know much about quality of care within hospitals and a study could discover if there are racial differences.

Dr. South-Paul agreed: "I think we've assumed that we treat everybody the same and all things are equal. I don't believe that at all."

Some proposed community-based interventions in the paper include better management of chronic disease and changes to vaccination guidelines, Dr. Yende said.

Changes to vaccination guidelines for black patients could be helpful because current guidelines mean that up to 25 percent of the cases occurring among blacks are missed, he said. The study said about 74 percent of the cases of pneumonia in blacks occurred in patients younger than 65. In contrast, only 45 percent of white patients with pneumonia were in that younger age group.

The pneumococcal vaccine is currently recommended for use in infants and adults over 65 and for individuals 2 years old and up who are at high risk for disease, have asthma, or smoke, according to Centers for Disease Control and Prevention guidelines.

Dr. Yende said that he and his team will continue research to examine the role of biological differences and to determine if black patients respond differently to infection.

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