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. 2018 Feb 12;16(1):4.
doi: 10.1186/s12963-018-0160-x.

Epidemiological trends of sepsis in the twenty-first century (2000-2013): an analysis of incidence, mortality, and associated costs in Spain

Alejandro Álvaro-Meca  1 , María A Jiménez-Sousa  2 , Dariela Micheloud  3 , Ainhoa Sánchez-Lopez  4 , María Heredia-Rodríguez  4 , Eduardo Tamayo  4 , Salvador Resino  5 ; Group of Biomedical Research in Critical Care Medicine (BioCritic)
Affiliations

Epidemiological trends of sepsis in the twenty-first century (2000-2013): an analysis of incidence, mortality, and associated costs in Spain

Alejandro Álvaro-Meca et al. Popul Health Metr. .

Abstract

Background: Sepsis has represented a substantial health care and economic burden worldwide during the previous several decades. Our aim was to analyze the epidemiological trends of hospital admissions, deaths, hospital resource expenditures, and associated costs related to sepsis during the twenty-first century in Spain.

Methods: We performed a retrospective study of all sepsis-related hospitalizations in Spanish public hospitals from 2000 to 2013. Data were obtained from records in the Minimum Basic Data Set. The outcome variables were sepsis, death, length of hospital stay (LOHS), and sepsis-associated costs. The study period was divided into three calendar periods (2000-2004, 2005-2009, and 2010-2013).

Results: Overall, 2,646,445 patients with sepsis were included, 485,685 of whom had died (18.4%). The incidence of sepsis (events per 1000 population) increased from 3.30 (2000-2004) to 4.28 (2005-2009) to 4.45 (2010-2013) (p < 0.001). The mortality rates from sepsis (deaths per 10,000 population) increased from 6.34 (2000-2004) to 7.88 (2005-2009) to 7.89 (2010-2013) (p < 0.001). The case fatality rate (CFR) or proportion of patients with sepsis who died decreased from 19.1% (2000-2004) to 18.4% (2005-2009) to 17.9% (2010-2013) (p < 0.001). The LOHS (days) decreased from 15.9 (2000-2004) to 15.7 (2005-2009) to 14.5 (2010-2013) (p < 0.001). Total and per patient hospital costs increased from 2000 to 2011, and then decreased by the impact of the economic crisis.

Conclusions: Sepsis has caused an increasing burden in terms of hospital admission, deaths, and costs in the Spanish public health system during the twenty-first century, but the incidence and mortality seemed to stabilize in 2010-2013. Moreover, there was a significant decrease in LOHS in 2010-2013 and a decline in hospital costs after 2011.

Keywords: Case fatality rate; Cost; Epidemiology; Hospital resources; Length of hospital stay; Mortality; Sepsis.

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Conflict of interest statement

Authors’ information

Not applicable.

Ethics approval and consent to participate

This study involves the use of patient medical data from the Spanish Minimum Basic Data Set (MBDS), which is hosted by the Ministry of Health Social Services and Equality (MSSSI). The MBDS is regulated by Spanish law, which explains how institutions are required to utilize health-related personal data. The data were treated with full confidentiality accord6ing to Spanish legislation. The MSSSI evaluated the protocol of our investigation and considered it to meet all ethical aspects according to Spanish legislation. Given the anonymous and mandatory nature of the dataset, it was not necessary to obtain informed consent. Furthermore, our study was approved by the Research Ethic Committee (Comité de Ética de la Investigación y de Bienestar Animal) of the Instituto de Salud Carlos III (Madrid, Spain).

Consent for publication

Not applicable.

Competing interests

The authors do not have any commercial or other association that might pose a conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trends of percentage of patients with sepsis and percentage of sepsis-related deaths among all hospital admissions and deaths
Fig. 2
Fig. 2
Trends of sepsis incidence, sepsis-related mortality, and case fatality rate in Spain from 2000 to 2013. a Population-adjusted incidence of sepsis; b Population-adjusted mortality related to sepsis; c Case fatality rate or proportion of deaths among patients hospitalized with sepsis
Fig. 3
Fig. 3
National age-specific rates (incidence, mortality, and case fatality rate) for sepsis in Spain (2000–2013) stratified by calendar periods. a incidence; b sepsis-related mortality; c case fatality rate or proportion of deaths among patients hospitalized with sepsis
Fig. 4
Fig. 4
Evolution of cost and length of hospital stay for patients with sepsis in Spain from 2000 to 2013. a Average length of hospital stay (LOHS) per patient; b average cost per patient; c average total cost
Fig. 5
Fig. 5
Age-specific hospital resource expenditure in Spain from 2000 to 2013 stratified by calendar periods. a average length of hospital stay (LOHS) per patient; b average cost per patient; c average total cost
See this image and copyright information in PMC

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