Spatial association between socio-economic health service factors and sepsis mortality in Thailand

Sepsis is a significant global health issue causing organ failure and high mortality. The number of sepsis cases has recently increased in Thailand making it crucial to comprehend the factors behind these infections. This study focuses on exploring the spatial autocorrelation between socio-economic factors and health service factors on the one hand and sepsis mortality on the other. We applied global Moran's I, local indicators of spatial association (LISA) and spatial regression to examine the relationship between these variables. Based on univariate Moran's I scatter plots, sepsis mortality in all 77 provinces in Thailand were shown to exhibit a positive spatial autocorrelation that reached a significant value (0.311). The hotspots/ high-high (HH) clusters of sepsis mortality were mostly located in the central region of the country, while the coldspots/low-low (LL) clusters were observed in the north-eastern region. Bivariate Moran's I indicated a spatial autocorrelation between various factors and sepsis mortality, while the LISA analysis revealed 7 HH clusters and 5 LL clusters associated with population density. Additionally, there were 6 HH and 4 LL clusters in areas with the lowest average temperature, 4 HH and 2 LL clusters in areas with the highest average temperature, 8 HH and 5 LL clusters associated with night-time light and 6 HH and 5 LL clusters associated with pharmacy density. The spatial regression models conducted in this study determined that the spatial error model (SEM) provided the best fit, while the parameter estimation results revealed that several factors, including population density, average lowest and highest temperature, night-time light and pharmacy density, were positively correlated with sepsis mortality. The coefficient of determination (R2) indicated that the SEM model explained 56.4% of the variation in sepsis mortality. Furthermore, based on the Akaike Information Index (AIC), the SEM model slightly outperformed the spatial lag model (SLM) with an AIC value of 518.1 compared to 520.