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 PMID27105174show ga
Objective: In the United States (US) sepsis is a major public health problem accounting for over 200,000 annual deaths. The aims of this study were to identify US counties with high sepsis mortality and to assess the community characteristics associated with sepsis mortality. Design: We performed a descriptive analysis of 2003 through 2012 Compressed Mortality File (CMF) data summarized at the county level. We defined sepsis deaths as deaths associated with an infection as the CMF is derived from death certificates and classified according to the International Classification of Diseases, Version 10 (ICD-10). Measurements: We identified county-level sepsis clustering groups: strongly clustered, moderately clustered, and non-clustered. 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. Main Results: Among 3,108 US counties, the age-adjusted sepsis mortality rate was 59.6 deaths per 100,000 persons (95% CI: 58.9 ? 60.4). Among 161 (5.2%) counties categorized as strongly clustered, the age-adjusted sepsis mortality rate 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), had lower education, larger population in poverty, without medical insurance, and higher unemployment rates (p < 0.001). Conclusion: Sepsis mortality clustering is prevalent in Southern US, with three definitive sepsis clusters: ?Mississippi Valley?, ?Middle Georgia?, and ?Central Appalachia,? characterized by lower education, income, employment and insurance coverage.
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Crit+Care+Med 2016 ; 44 (7): 1380-7
