(1497) Association Between Stigmatizing Language Occurrence in Notes and Outcomes in Patients With Sepsis

Introduction: Stigmatizing language is language that assigns negative labels or stereotypes to certain groups of people. Previous studies have found that patient characteristics are a factor in receiving stigmatizing language in clinical notes. Such language can serve as a surrogate for the healthcare provider's implicit or explicit bias, may influence patient care, and adversely impact outcomes, especially for patients with life-threatening conditions such as sepsis. Here, we determine if the presence of stigmatizing language in notes was associated with outcomes in patients with sepsis.

Methods: We conducted a retrospective study of ICU patients with an ICD diagnosis code of sepsis within the MIMIC-III cohort. Clinical notes were analyzed using automated and manual methods to identify stigmatizing language, defined by the NIH NIDA list of words representing stigma around addiction. We compared characteristics and outcomes between patients with and without stigmatizing language. We also conducted a multiple logistic regression analysis to determine the association between in-hospital mortality and the use of stigmatizing language after adjusting for age, sex, race/ethnicity, admission vital signs, and diagnosis of substance use disorder (SUD).

Results: Out of 18,386 sepsis patients, 2,926 (15.9%) had at least one note with stigmatizing language. Sepsis patients with stigmatizing language were more likely to be younger (median age 57 vs. 69 years, P< 0.001), male (66% vs. 53%, P< 0.001), Black (9% vs 8%, P< 0.001), and diagnosed with SUD (50% vs. 4%, P< 0.001) compared to patients without. They were also less likely to receive vasoactive medications (29% vs. 36%, P< 0.001) and more likely to receive antibiotics later (median time 4 vs. 3 hours, P< 0.001). After adjusting for confounders, stigmatizing language use was associated with an increased risk of mortality (OR 1.23; 95%CI: 1.06-1.43, P=0.007). The association was more pronounced in patients with SUD (OR 2.11; 95%CI 1.49-3.05, P< 0.001) than others (OR 1.06; 95% CI 0.88-1.26, P=0.540).

Conclusions: The presence of stigmatizing language in clinical notes among ICU patients with sepsis was associated with increased mortality, especially in patients with SUD. Validation in other hospitals is necessary to determine the generalizability of our findings.