Racial and Ethnic Disparities in Clinical Characteristics and Outcomes in Adults With Encephalitis: A Retrospective Study.

BACKGROUND AND

OBJECTIVES

This study aims to assess whether adult patients with encephalitis from different racial and ethnic backgrounds exhibit significant differences in clinical presentation, diagnostic findings, and outcomes.

DESIGN AND

METHODS

A retrospective cohort study was conducted by utilizing the electronic health records of encephalitis patients in the greater Houston and Baltimore areas. Patients were categorized by race/ethnicity into White or ethnic minority (including Black, Hispanic, and Asian patients). Data was analyzed for the presence of significant differences in clinical characteristics between the two groups.

RESULTS

Among 599 patients, 312 (52.1%) were White and 287 (47.9%) were of an ethnic minority. White patients were more often over sixty years-old upon presentation (43.1% vs 23.9%, P < 0.001) and more likely to present with memory deficits (36% vs 26.3%, P = 0.012). Ethnic minority patients more frequently presented with co-existing HIV (20.3% vs 3.4%, P < 0.001), severe organ dysfunction (44% vs 34.4%, P = 0.028), cerebrospinal fluid (CSF) pleocytosis (white blood cell count ≥5 cells/µL) (83.1% vs 69.3%, P < 0.001), and abnormal electroencephalogram (EEG) findings (84.3% vs 71.9%, P = 0.035). Ethnic minority patients also had worse outcomes on the Glasgow Outcome Scale (GOS) as defined by GOS <4 (59.3% vs 47.2%, P = 0.005). Binary logistic regression identified abnormal magnetic resonance imaging (MRI) and Glasgow Coma Scale (GCS) <13 as independent predictors of an adverse clinical outcome (GOS <4) with an adjusted odds ratio [95% confidence interval] (P value) of 1.609 [1.042-2.486] (P = 0.032) and 2.689 [1.675-4.317] (P < .001), respectively.

CONCLUSION

Ethnic minority patients with encephalitis present at a younger age and are more likely to have co-existing HIV, severe initial organ dysfunction, CSF pleocytosis, abnormal EEG findings, and worse clinical outcomes. Abnormal MRI and GCS <13 are independent predictors of an unfavorable clinical outcome and may aid in risk stratification.