Defining Sepsis Mortality Clusters in the United States.
Defining Sepsis Mortality Clusters in the United States.
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DOI：
10.1097/ccm.0000000000001665
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发表时间：
2016-07
影响因子：
8.8
通讯作者：
Wang HE
中科院分区：
文献类型：
--
作者：
Moore JX;Donnelly JP;Griffin R;Howard G;Safford MM;Wang HE
在美国，脓毒症是一个主要的公共卫生问题，每年导致超过 20 万人死亡。本研究的目的是确定美国败血症死亡率较高的县，并评估与败血症死亡率相关的社区特征。我们对 2003 年至 2012 年县级汇总的压缩死亡率文件 (CMF) 数据进行了描述性分析。我们将败血症死亡定义为与感染相关的死亡，因为 CMF 源自死亡证明并根据国际疾病分类第 10 版 (ICD-10) 进行分类。我们确定了县级脓毒症聚集性群体：强聚集性、中度聚集性和非聚集性。我们估算了全国和聚类群体的平均粗死亡率、年龄调整死亡率和社区调整败血症死亡率。我们对比了聚类群体之间的人口和社区特征。我们对高度聚集的县和社区特征之间的关联进行了逻辑回归。在美国 3,108 个县中，年龄调整后的败血症死亡率为每 10 万人中有 59.6 人死亡（95% CI：58.9 – 60.4）。在 161 个（5.2%）高度聚集的县中，年龄调整后的败血症死亡率为每 10 万人 93.1 人死亡（95% CI：90.5 – 95.7）。脓毒症高度聚集的县更有可能位于南部（92.6%，p <0.001），教育程度较低，贫困人口较多，没有医疗保险，失业率较高（p <0.001）。脓毒症死亡集群在美国南部普遍存在，存在三个明确的脓毒症集群：“密西西比河谷”、“乔治亚州中部”和“阿巴拉契亚中部”，其特点是教育、收入、就业和保险覆盖率较低。
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. 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). 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. 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). 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.