Regional differences in severe sepsis epidemiology and treatment in Germany

败血症是感染性疾病最严重的并发症，也是全球死亡率的主要原因。根据世界卫生组织的数据，每年600万脓毒症死亡中的大多数是可以避免的。在德国，每年有130.000名严重脓毒症患者在医院接受治疗，其中43%死亡。脓毒症的住院和门诊治疗总费用为77亿欧元，是德国医疗保健系统中最昂贵的疾病之一。德国联邦各州在脓毒症发病率和住院死亡率方面存在显著差异。除此之外，败血症的发病率正在随着时间的推移而增加，德国的医院死亡率被发现高于美国或澳大利亚等其他州。这些观察结果的原因在很大程度上仍不清楚。因此，这项初步研究旨在调查联邦州和地区之间在脓毒症流行病学和治疗方面的地区差异。这项生态学研究以德国联邦统计局的诊断相关群体统计(DRG Statistics)为基础，将测试与其他数据来源的联系，包括社会经济、结构和基于患者的数据。脓毒症和脓毒症死亡的相关风险因素将在现有数据来源中运作，并与模式年的DRG统计数据联系起来。年龄和性别标准化的发病率和死亡率以及住院治疗的特点将在德国联邦州和地区的水平上进行评估。为了评估脓毒症发病率和住院死亡率与危险因素之间的统计关系，将使用回归模型和空间回归模型。这一结果将使人们更好地了解德国败血症的流行病学。对于一个典型年，将测试用于分析脓毒症和脓毒症死亡的风险因素的数据联系的可行性。这项研究将为进一步的研究产生假设。可以确定败血症发病率和死亡率显著较低的模范区域，并将其作为最佳实践范例。从长远来看，可以根据这项研究中获得的知识，设计和实施旨在减少脓毒症负担和治疗成本的有针对性的倡议。

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.