Defining Sepsis Mortality Clusters in the United States*
- 1 July 2016
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 44 (7), 1380-1387
- https://doi.org/10.1097/ccm.0000000000001665
Abstract
In the United States, sepsis is a major public health problem accounting for over 200,000 annual deaths. The aims of this study were to identify U.S. counties with high sepsis mortality and to assess the community characteristics associated with increased sepsis mortality. We performed a descriptive analysis of 2003 through 2012 Compressed Mortality File data. We defined sepsis deaths as deaths associated with an infection, classified according to the International Classification of Diseases, 10th Version. Three thousand one hundred and eight counties in the contiguous U.S. counties, excluding Hawaii and Alaska. Using geospatial autocorrelation methods, we defined county-level sepsis mortality as strongly clustered, moderately clustered, and nonclustered. We approximated the mean crude, age-adjusted, and community-adjusted sepsis mortality rates nationally and for clustering groups. We contrasted demographic and community characteristics between clustering groups. We performed logistic regression for the association between strongly clustered counties and community characteristics. Among 3,108 U.S. counties, the age-adjusted sepsis mortality rate was 59.6 deaths per 100,000 persons (95% CI, 58.9–60.4). Sepsis mortality was higher in the Southern U.S. and clustered in three major regions: Mississippi Valley, Middle Georgia, and Central Appalachia. Among 161 (5.2%) strongly clustered counties, age-adjusted sepsis mortality was 93.1 deaths per 100,000 persons (95% CI, 90.5–95.7). Strongly clustered sepsis counties were more likely to be located in the south (92.6%; p < 0.001), exhibit lower education, higher impoverished population, without medical insurance, higher medically uninsured rates, and had higher unemployment rates (p < 0.001). Sepsis mortality is higher in the Southern United States, with three regional clusters: “Mississippi Valley,” “Middle Georgia,” and “Central Appalachia”: Regions of high sepsis mortality are characterized by lower education, income, employment, and insurance coverage.Keywords
This publication has 45 references indexed in Scilit:
- The Effect of Insurance Status on Mortality and Procedural Use in Critically Ill PatientsAmerican Journal of Respiratory and Critical Care Medicine, 2011
- Socioeconomic and Racial/Ethnic Disparities in the Incidence of Bacteremic Pneumonia Among US AdultsAmerican Journal of Public Health, 2010
- National variation in United States sepsis mortality: a descriptive studyInternational Journal of Health Geographics, 2010
- Socioeconomic and Race/Ethnic Patterns in Persistent Infection Burden Among U.S. AdultsThe Journals of Gerontology: Series A, 2009
- Socioeconomic risk factors for bacteraemic pneumococcal pneumonia in adultsEpidemiology and Infection, 2008
- Racial Variation in the Incidence, Care, and Outcomes of Severe SepsisAmerican Journal of Respiratory and Critical Care Medicine, 2008
- How does lack of insurance affect use of intensive care? A population-based study*Critical Care Medicine, 2006
- Is the Stroke Belt Disappearing?Stroke, 1995
- The Geography of Stroke Mortality in the United States and the Concept of a Stroke BeltStroke, 1995
- The Shifting Stroke BeltStroke, 1995