Disease Burden And Related Factors Of Sepsis-related Deaths In China

BackgroundSepsis remains the most common cause of death in critically ill patients,which causes or contributes to between one-third and one-half of all deaths in hospitals.While there are no approved specific molecular therapies for sepsis,management of these critically ill patients relies on early recognition,appropriate antibiotics and supportive care.Global and national data on the epidemiology of sepsis are an important prerequisite to develop appropriate health care policy and to allocate limited health care resources.Epidemiological data of sepsis in China are scarce.A population-level description and analysis of sepsis-related mortality in China is key to the planning and assessment of interventional strategies.ObjectiveWe conducted a study of the national mortality surveillance system(NMSS)in order to determine estimates of sepsis-related mortality in China.In addition,we sought to evaluate variation in sepsis-related mortality among provinces and its contributing factors.MethodsWe built and validated a strategy of ICD-10 coding algorithm to identify sepsis-related deaths.We retrospectively analyzed multiple cause of death(MCOD)with ICD-10 coding algorithm based on NMSS of China.All sepsis-related deaths occurring in 605 disease surveillance points(DSPs)covering 323.8 million population across China were identified.Age-standardized mortality and national estimate of sepsis related deaths were estimated using the census population in 2010 and 2015 respectively.Multilevel Poisson regression was used to investigate whether there are geographic variations across different provinces/DSPs in sepsis mortality.ResultsIn 2015,a total of 1,937,299 deaths occurring in any of the 605 DSPs,standardized sepsis-related mortality rate was 66.7(95%confidence interval[CI]66.4-67.0)deaths per 100,000 population.This produced a national estimate of 1,025,997 sepsis-related deaths.Sepsis-related mortality rates exhibited significant geographic variation.In multilevel analysis,male sex(rate ratio[RR]1.582,95%CI 1.570-1.595),increasing age(RR 1.914 for 5-year group,95%CI 1.910-1.917),and presence of comorbidity(RR 2.316,95%CI 2.298-2.335)were independently associated with increased sepsis-related mortality.Higher disposable income(RR 0.717 for the 4th interquartile range vs.the 1st interquartile range,95%CI 0.515-0.978)and mean years of education(RR 0.808 for the 4th interquartile range vs.the 1st interquartile range,95%CI 0.684-0.955)were negatively associated with sepsis-related mortality,However,population-based hospital doctors were not significantly associated with sepsis-related mortality.ConclusionsThe standardized sepsis-related mortality rate in China was high and varied according to socioeconomic indices,even though some uncertainty remained.