Risk Factors for Sepsis in the Community

描述(由申请人提供)：败血症，一种对公共卫生具有巨大重要性的疾病，在美国具有两个地区的死亡率差异，最高的聚集性在美国东南部。很少有研究有大规模的、全国性的、基于人口的设计来解释这些地区差异。我们拟议的研究将利用30,000名以社区为基础的队列受试者的基础设施，这些基础设施具有识别个人和社区水平的脓毒症危险因素及其对区域脓毒症变异的中介作用所需的要素。我们的研究将通过确定适合降低风险的个人和社区水平的因素来推动败血症科学的发展，潜在地导致预防败血症和降低其高死亡率的策略。我们的研究目标是1)确定与脓毒症发病率和病死率相关的个人、家庭、社区和社会/系统卫生保健因素，以及2)确定它们对区域脓毒症变异的中介作用。脓毒症是一种由微生物感染引发的全身炎症的危险综合征。败血症可能损害重要器官，导致休克和死亡。败血症是一个主要的社区威胁，在美国每年导致超过75万人住院和21.5万人死亡--超过了急性心肌梗死、肺癌或乳腺癌造成的死亡。我们最近的研究表明，美国东南部有一个超额脓毒症死亡率两倍的“带”，反映了每年近8500人超额脓毒症死亡。为了了解脓毒症死亡率区域差异的原因，一项研究必须能够确定与脓毒症发病率和病死率相关的院前个人和社区水平的危险因素。然而，很少有研究采用大规模、全国性、以人群为基础的设计来检验这些关系。我们建议对中风中的地理和种族差异的原因进行一项辅助研究，这是一项由NINDS资助的国家队列研究，由30,000名居住在社区的成年人组成。使用这项大型队列研究的成熟基础设施，我们将确定脓毒症的住院和死亡情况，利用10年间超过3300起事件。我们将测试基线个人和社区医疗保健相关特征(资源、获得和护理质量)与事件脓毒症和28天脓毒症死亡(病死率)之间的关联，确定它们对区域脓毒症变异的中介影响。这项研究的具体目的是：1)确定美国脓毒症易感性(发病率)和病死率的地理变异；2)确定影响脓毒症地理变异的个人和家庭特征；3)确定影响脓毒症地理变异的社区和社会/系统医疗保健特征。

DESCRIPTION (provided by applicant): Sepsis, a condition of enormous public health importance, has two-fold regional variation in mortality in the US, with the highest cluster in the Southeastern US. Few studies have had the large-scale, national, population-based design required to explain these regional variations. Our proposed study will capitalize on the infrastructure of the 30,000 subject REGARDS community-based cohort, which has the elements needed to identify individual and community-level sepsis risk factors and their mediating effects on regional sepsis variations. Our study will advance sepsis science by identifying individual and community-level factors amenable to risk reduction, potentially leading to strategies to prevent sepsis and reduce its high mortality. Our study objectives are 1) identify individual, family, community and societal/system healthcare factors associated with sepsis attack rates and case fatality, and 2) determine their mediating effects on regional sepsis variations. Sepsis is a dangerous syndrome of body-wide systemic inflammation triggered by microbial infection. Sepsis may injure vital organs, resulting in shock and death. Sepsis is a major community threat, resulting in over 750,000 hospitalizations and 215,000 deaths in the US annually - exceeding deaths resulting from acute myocardial infarction, lung cancer or breast cancer. Our recent study indicates a Southeastern US "belt" of two-fold excess sepsis mortality, reflecting almost 8,500 excess sepsis deaths annually. To understand the reasons for regional variations in sepsis mortality, a study must be able to identify the pre-hospital individual and community-level risk factors associated with sepsis attack rates and case fatality. However, few studies have had the large-scale, national, population-based design required to examine these relationships. We propose an ancillary study to the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study, an ongoing NINDS-funded national cohort of >30,000 community-dwelling adults. Using the well- established infrastructure of this large cohort study, we will identify sepsis hospitalizations and deaths, drawing upon over 3,300 events across a 10-year span. We will test associations between baseline individual and community healthcare-related characteristics (resources, access and quality of care) and the risks of incident sepsis and 28-day sepsis death (case fatality), determining their mediating influences on regional sepsis variations. The specific aims of this study are to 1) Determine US geographic variations in sepsis susceptibility (attack rate) and case fatality, 2) Determine the individual and family characteristics that mediate sepsis geographic variations and 3) Determine the community and societal/system healthcare characteristics that mediate sepsis geographic variations.