Regional differences in severe sepsis epidemiology and treatment in Germany

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Sepsis, the most severe complication of infectious diseases, is a major contributor to global mortality. According to the World Health Organization, the majority of the annual six million sepsis deaths are avoidable. In Germany, 130.000 patients with severe sepsis are treated in hospital every year, of which 43% die. With overall costs of €7.7 billion Euro for sepsis inpatient and outpatient treatment, sepsis is one of the most expensive conditions in the German health care system. Substantial differences in sepsis incidence and hospital mortality exist between the German federal states. Above that, sepsis incidence is increasing over time, and hospital mortality is found to be higher in Germany than in other states such as the US or Australia. The causes of these observations remain largely unknown. Therefore, this pilot study aims to investigate regional differences in sepsis epidemiology and treatment between federal states and districts. This ecological study bases on the Diagnosis-Related Group Statistics (DRG Statistics) of the German Federal Statistical Office, for which a linkage with other data sources including socioeconomic, structural and patient-based data will be tested. Relevant risk factors for sepsis and death from sepsis will be operationalised in available data sources and linked to the DRG statistics for a model year. Age- and sex-standardized incidence and mortality rates as well as characteristics of inpatient treatment will be assessed on the level of federal states and districts in Germany. To evaluate the statistical relation between sepsis incidence and hospital mortality and the risk factors, regression model spatial regression models will be applied. The results will provide a better understanding of the epidemiology of sepsis in Germany. For a model year, the feasibility of data linkage for the analysis of risk factors for sepsis and death from sepsis will be tested. The study will generate hypotheses for further research. Model regions with remarkable low sepsis incidence and mortality can be identified and serve as best practice examples. In the long run, targeted initiatives aiming to reduce the burden of sepsis and costs for treatment can be designed and implemented based on the knowledge gained in this study.