Risk Factors for Sepsis in the Community

描述（由申请人提供）：脓毒症是一种具有巨大公共卫生重要性的疾病，在美国的死亡率具有双重区域差异，其中美国东南部的聚集性最高。很少有研究有大规模的，全国性的，以人口为基础的设计来解释这些地区的差异。我们拟议的研究将利用30，000名受试者REGARDS社区队列的基础设施，该队列具有识别个体和社区水平脓毒症风险因素及其对区域脓毒症变化的介导作用所需的要素。我们的研究将通过识别适合降低风险的个人和社区因素来推进脓毒症科学，可能导致预防脓毒症和降低其高死亡率的策略。我们的研究目的是1）确定与脓毒症发作率和病死率相关的个人、家庭、社区和社会/系统医疗保健因素，2）确定其对局部脓毒症变异的介导作用。脓毒症是由微生物感染引起的全身性炎症的危险综合征。脓毒症可损伤重要器官，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750，000例住院治疗和215，000例死亡-超过急性心肌梗死、肺癌或乳腺癌导致的死亡。我们最近的研究表明，美国东南部的败血症死亡率高出两倍，每年约有8,500例败血症死亡。为了了解脓毒症死亡率区域差异的原因，研究必须能够确定与脓毒症发作率和病死率相关的院前个体和社区水平的危险因素。然而，很少有研究有大规模的，全国性的，以人口为基础的设计需要检查这些关系。我们建议对卒中的地理和种族差异原因（REGARDS）研究进行辅助研究，该研究是一项由NINDS资助的超过30，000名社区居住成年人的国家队列研究。利用这项大型队列研究的完善基础设施，我们将确定脓毒症住院和死亡，在10年的跨度内绘制超过3，300个事件。我们将测试基线个人和社区卫生保健相关特征（资源，获得和护理质量）与败血症事件和28天败血症死亡（病死率）风险之间的关联，确定其对区域败血症变化的介导影响。本研究的具体目的是：1）确定脓毒症易感性（发病率）和病死率的美国地理差异，2）确定介导脓毒症地理差异的个体和家族特征，3）确定介导脓毒症地理差异的社区和社会/系统医疗保健特征。 公共卫生相关性：脓毒症是一种危及生命的疾病，由肺炎、肾脏感染、蜂窝织炎或脑膜炎等感染引发的全身炎症组成。这项研究将确定某些个人或社区是否容易发生败血症。这项研究的信息将支持减少或预防社区败血症的策略。.

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. PUBLIC HEALTH RELEVANCE: Sepsis is a life-threatening condition consisting of body-wide inflammation triggered by infections such as pneumonia, kidney infection, cellulitis or meningitis. This study will determine if certain individuals or communities are prone to develop sepsis. Information from this study will support strategies to reduce or prevent sepsis in the community. .