Multinational trends in sepsis mortality between 1985 and 2019: a temporal analysis of the WHO Mortality Database

Abstract

Objectives: Understanding the burden of disease of sepsis is essential for monitoring the effectiveness of international strategies to improve sepsis care. Our objective was to describe the multinational trend of sepsis-related mortality for the period 1985-2019 from the WHO Mortality Database.

Design: Retrospective analysis of the WHO Mortality Database.

Setting: We included data from all countries defined by the WHO as having 'high usability data' and at least 10 years of total available data.

Participants: From the WHO list of 50 countries with high usability data, 14 (28%) were excluded due to excessive missingness. We included and analysed data separately for male and female.

Primary and secondary outcome measures: We analysed age-standardised mortality rates (ASMR) (weighted average of the age-specific mortality rates per 100 000 people, where the weights are the proportions of people in the corresponding age groups of the WHO standard population).

Results: We included 1104 country-years worth of data from 36 countries with high usability data, accounting for around 15% of the world's population. The median ASMR for men decreased from 37.8 deaths/100 000 (IQR 28.4-46.7) in 1985-1987 to 25.8 deaths/100 000 (IQR 19.2-37) in 2017-2019, an approximately 12% absolute (31.8% relative) decrease. For women, the overall ASMR decreased from 22.9 deaths/100 000 (IQR 17.7-32.2) to 16.2 deaths/100 000 (IQR 12.6-21.6), an approximately 6.7% absolute decrease (29.3% relative decrease). The analysis of country-level data revealed wide variations in estimates and trends.

Conclusions: We observed a decrease in reported sepsis-related mortality across the majority of analysed nations between 1985 and 2019. However, significant variability remains between gender and health systems. System-level and population-level factors may contribute to these differences, and additional investigations are necessary to further explain these trends.

Keywords: epidemiology; infectious diseases; intensive & critical care.

Figure 1. Multinational trend in age-standardised mortality rates (ASMR) of sepsis (Angus definition) per 100 000 population among the 36 included countries (weighted median±IQR), with LOESS regression. Full line represents male, dash-dotted line female. A decreasing trend in ASMR is observed for both genders, with ASMR decreasing faster in male.

Figure 2. Age-standardised mortality rate (ASMR) of sepsis (Angus definition) and joinpoint regression analysis in 36 included countries between 1985 and 2019 (or longest period with data available). Empty squares represent male, full squares female.