Key PointsQuestionDo conventionally understood mechanisms of disparities adequately explain differences in hospital length of stay (LOS) between racial and ethnic minority and nonminority groups?FindingsIn this cohort study of 102 362 adult patients with sepsis and/or acute respiratory failure (ARF), Black patients with sepsis and/or ARF had a hospital LOS that was 0.97 to 1.26 days longer than White patients; in contrast, Hispanic patients with sepsis and ARF and Asian American and Pacific Islander patients with ARF were found to have a shorter hospital LOS than White patients. These findings were independent of the factors associated with disparities that were assessed.MeaningThese findings suggest that commonly understood factors associated with disparities related to clinical presentation and care in the intensive care unit are insufficient to account for racial and ethnic disparities in sepsis and ARF outcomes.