Clinical and epidemiological variability in severe sepsis: an ecological study

Area of Science:

• Epidemiology
• Public Health
• Critical Care Medicine

Background:

• Severe sepsis and septic shock represent significant public health challenges.
• Understanding clinical and epidemiological trends is crucial for effective healthcare strategies.
• Geographic variations in sepsis incidence and outcomes warrant investigation.

Purpose of the Study:

• To assess clinical and epidemiological trends of severe sepsis.
• To analyze incidence and mortality rates by age and medically underserved areas (MUAs).
• To examine changes in sepsis case fatality rate and patient transfer proportions over time.

Main Methods:

• Ecological study design utilizing a state-wide hospital administrative database.
• Inclusion of patients with severe sepsis or septic shock from 2005 to 2013.
• Analysis of incidence rates (IRs), mortality rates, case fatality rates, and transfer proportions, stratified by age and MUA status.

Main Results:

• 154,019 sepsis cases were identified.
• Incidence rates (IRs) for patients aged 85+ in non-MUAs increased by 44% (2005) to 74% (2013) compared to MUAs.
• Mortality rates were 1.6 times higher for 85+ year olds in non-MUAs; annual mortality increased 1.8%, while case fatality decreased 7.7%.

Conclusions:

• Sepsis incidence exhibits geographic variability, potentially linked to healthcare access.
• Improved sepsis recognition and management may contribute to capturing higher acuity cases.
• Differential diagnostic coding documentation by location could influence observed trends.