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. 2021 Sep 7;21(1):1636.
doi: 10.1186/s12889-021-11629-4.

Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany - an ecological study

Norman Rose  1   2 , Claudia Matthäus-Krämer  1 , Daniel Schwarzkopf  2   3 , André Scherag  4 , Sebastian Born  1   2 , Konrad Reinhart  5 , Carolin Fleischmann-Struzek  6   7
Affiliations

Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany - an ecological study

Norman Rose et al. BMC Public Health. .

Abstract

Background: Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking.

Methods: Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions.

Results: In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts.

Conclusions: Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany.

Keywords: Ecological study; Incidence; Medical services; Sepsis; Socioeconomic factors.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow of study inclusion
Fig. 2
Fig. 2
Distribution of crude and age-standardized explicitly defined sepsis (R65.1 – severe sepsis, R57.2 septic shock according to the 1992 sepsis-1 definitions [18]) incidence across German districts. Maps were created using the ‘spplot’ function from the ‘sp’ package [31, 32]. Geodata and shapefiles for creating maps of Germany in R were retrieved from https://gadm.org/. The maps are freely available for academic use
Fig. 3
Fig. 3
Distribution of explicitly defined sepsis incidence across German federal states and districts
See this image and copyright information in PMC

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