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. 2018 Aug;72(8):741-745.
doi: 10.1136/jech-2018-210501. Epub 2018 Apr 10.

Clinical and epidemiological variability in severe sepsis: an ecological study

J Priyanka Vakkalanka  1   2 , Karisa K Harland  1   2 , Morgan B Swanson  1   2 , Nicholas M Mohr  1   2   3
Affiliations

Clinical and epidemiological variability in severe sepsis: an ecological study

J Priyanka Vakkalanka et al. J Epidemiol Community Health. 2018 Aug.

Abstract

Background: To assess clinical and epidemiological trends of severe sepsis.

Methods: Ecological study of patients presenting to the emergency department with severe sepsis or septic shock between 2005 and 2013. Patients were identified using the state-wide hospital administrative database. Key outcomes included incidence rates (IRs) and mortality rates (per 1000 population) by age and medically underserved areas (MUAs), sepsis case fatality rate (deaths per 100 sepsis cases), and proportions of transfer and comorbidities.

Results: There were 154 019 sepsis cases identified. In 2005, 85+ yo in non-MUAs had a 44% increase in IR compared with those in MUAs, and this difference rose to 74% by 2013. Mortality rates were 1.6 (95% CI 1.3 to 1.8) times greater among 85+ yo in non-MUAs. Mortality rates increased by 1.8% annually, while the sepsis case fatality rate decreased by 7.7%. The proportion of transfer among sepsis cases decreased by 2.1% per year (3.8% in non-MUAs, 0.7% in MUAs).

Conclusions: Sepsis incidence varies geographically, and access to healthcare is one proposed mechanism that may explain heterogeneity. Over time, we may be capturing higher acuity sepsis cases with better recognition and management, as well as observing differential diagnostic coding documentation by location.

Keywords: epidemiology of aging; geography; inequalities; infection; mortality.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1.
Figure 1.. Sepsis Incidence Rates, Mortality Rates, and Case Fatality Rates in Iowa, 2005–2013.
A) Presents the incidence rate per 1,000 population for each age group. B) Presents the mortality rate per 1,000 population for each age group. C) Presents sepsis case fatality rates (i.e. deaths per 100 sepsis cases).
Figure 2.
Figure 2.. Mortality Rates of Sepsis (per 1,000 Population) by Medically Underserved Area Status, 2005–2013
A) Incidence rate (sepsis cases per 1,000 population) and B) Mortality rate (deaths per 1,000 population) by county type. MUA = medically underserved area; Non-MUA = non-medically underserved area.
Figure 3.
Figure 3.. Proportion of Co-morbidities among Patients with Sepsis
Number of cases with each co-morbidity per 100 sepsis cases. CHF = coronary heart failure.
See this image and copyright information in PMC

References

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