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2016 ; 44
(7
): 1380-7
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Defining Sepsis Mortality Clusters in the United States
#MMPMID27105174
Moore JX
; Donnelly JP
; Griffin R
; Howard G
; Safford MM
; Wang HE
Crit Care Med
2016[Jul]; 44
(7
): 1380-7
PMID27105174
show ga
OBJECTIVES: 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. DESIGN: 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. SETTING:
Three thousand one hundred and eight counties in the contiguous U.S. counties,
excluding Hawaii and Alaska. MEASUREMENTS AND MAIN RESULTS: 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). CONCLUSIONS: 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.
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