Log in | Register

Sepsis-related mortality in China: a descriptive analysis

Li Weng| Xin-ying Zeng| Peng Yin| Li-jun Wang| Chun-yao Wang| Wei Jiang| Mai-geng Zhou| Bin Du
Original
Volume 44, Issue 7 / July , 2018

Pages 1071 - 1080

Abstract

Purpose

A population-level description and analysis of sepsis-related mortality in China is key to the planning and assessment of interventional strategies.

Methods

Retrospective analysis of multiple cause of death (MCOD) recorded in the population-based national mortality surveillance system (NMSS) of China. All sepsis-related deaths occurring in 605 disease surveillance points (DSPs) covering 323.8 million population across China were included in our study. Age-standardized mortality and national estimate of sepsis-related deaths were estimated using the census population in 2010 and 2015, respectively.

Results

In 2015, a total of 1,937,299 deaths occurring in any of the 605 DSPs and 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 fourth interquartile range vs. the first interquartile range, 95% CI 0.515–0.978) and mean years of education (RR 0.808 for the fourth interquartile range vs. the first 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.

Conclusions

The standardized sepsis-related mortality rate in China was high and varied according to socioeconomic indices, even though some uncertainty remained.

Keywords

References

  1. Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, Iwashyna TJ (2014) Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 312:90–92
    • View reference on publisher's website
    • View reference on PubMed
  2. Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, Angus DC, Reinhart K, International Forum of Acute Care Trialists (2016) Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med 193:259–272
    • View reference on publisher's website
    • View reference on PubMed
  3. Finfer S, Machado FR (2016) The global epidemiology of sepsis. Does it matter that we know so little? Am J Respir Crit Care Med 193:228–230
    • View reference on publisher's website
    • View reference on PubMed
  4. Cheng B, Xie G, Yao S, Wu X, Guo Q, Gu M, Fang Q, Xu Q, Wang D, Jin Y, Yuan S, Wang J, Du Z, Sun Y, Fang X (2007) Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Crit Care Med 35:2538–2546
    • View reference on publisher's website
    • View reference on PubMed
  5. Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, Ai Y, Xu Y, Liu D, An Y, Wu D, Sun R, Li S, Hu Z, Cao X, Zhou F, Jiang L, Lin J, Mao E, Qin T, He Z, Zhou L, Du B, China Critical Care Clinical Trials Group (2014) Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS One 9:e107181
    • View reference on publisher's website
    • View reference on PubMed
  6. Zhou J, Tian H, Du X, Xi X, An Y, Duan M, Weng L, Du B, China Critical Care Clinical Trials Group (CCCCTG) (2017) Population-based epidemiology of sepsis in a subdistrict of Beijing. Crit Care Med 45:1168–1176
    • View reference on publisher's website
    • View reference on PubMed
  7. Fedeli U, Piccinni P, Schievano E, Saugo M, Pellizzer G (2016) Growing burden of sepsis-related mortality in northeastern Italy: a multiple causes of death analysis. BMC Infect Dis 16:330
    • View reference on publisher's website
    • View reference on PubMed
  8. Taniguchi LU, Bierrenbach AL, Toscano CM, Schettino GPP, Azevedo LCP (2014) Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010. Crit Care 18:608
    • View reference on publisher's website
    • View reference on PubMed
  9. McPherson D, Griffiths C, Williams M, Baker A, Klodawski E, Jacobson B, Donaldson L (2013) Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open 3:e002586
    • View reference on publisher's website
    • View reference on PubMed
  10. Wang HE, Devereaux RS, Yealy DM, Safford MM, Howard G (2010) National variation in United States sepsis mortality: a descriptive study. Int J Health Geogr 9:9
    • View reference on publisher's website
    • View reference on PubMed
  11. Melamed A, Sorvillo FJ (2009) The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care 13:R28
    • View reference on publisher's website
    • View reference on PubMed
  12. Liu S, Wu X, Lopez AD, Wang L, Cai Y, Page A, Yin P, Liu Y, Li Y, Liu J, You J, Zhou M (2016) An integrated national mortality surveillance system for death registration and mortality surveillance, China. Bull World Health Organ 94:46–57
    • View reference on publisher's website
    • View reference on PubMed
  13. National Health and Family Planning Commission of the People’s Republic of China. Standard certificate of death in China. http://www.moh.gov.cn/ewebeditor/uploadfile/2014/01/20140113134120237.xls. Accessed 19 February 2018
  14. Centers for Disease Control and Prevention. Standard certificate of death in US. https://www.cdc.gov/nchs/data/dvs/blue_form.pdf. Accessed 19 February 2018
  15. World Health Organization. Strengthening civil registration and vital statistics for births, deaths and causes of death: resource kit. http://apps.who.int/iris/bitstream/10665/78917/1/9789241504591_eng.pdf. Accessed 19 February 2018
  16. World Health Organization. Improving mortality statistics through civil registration and vital statistics systems: strategies for country and partner support. http://www.who.int/healthinfo/civil_registration/CRVS_MortalityStats_Guidance_Nov2014.pdf. Accessed 19 February 2018
  17. Guo K, Yin P, Wang L, Ji Y, Li Q, Bishai D, Liu S, Liu Y, Astell-Burt T, Feng X, You J, Liu J, Zhou M (2015) Propensity score weighting for addressing under-reporting in mortality surveillance: a proof-of-concept study using the nationally representative mortality data in China. Popul Health Metr 13:16
    • View reference on publisher's website
    • View reference on PubMed
  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
    • View reference on publisher's website
    • View reference on PubMed
  19. Population census office under the state council and department of population and employment statistics of National Bureau of Statistics. Tabulation on the 2010 population census of People’s Republic of China. http://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm. Accessed 19 February 2018
  20. National Bureau of Statistics of China. China statistical yearbook 2015. http://www.stats.gov.cn/tjsj/ndsj/2015/indexeh.htm. Accessed 19 February 2018
  21. 2015 Year book of health and family planning in the People’s Republic of China. National Health and Family Planning Commission of the People’s Republic of China, Beijing, China
  22. National Bureau of Statistics of China. Statistical communiqué of the People’s Republic of China on the 2015 National Economic and Social Development. http://www.stats.gov.cn/english/PressRelease/201602/t20160229_1324019.html. Accessed 19 February 2018
  23. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RMH, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655
    • View reference on publisher's website
    • View reference on PubMed
  24. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310
    • View reference on publisher's website
    • View reference on PubMed
  25. Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK (2012) Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003–2007. Crit Care Med 40:754–761
    • View reference on publisher's website
    • View reference on PubMed
  26. GBD 2013 Mortality and Causes of Death Collaborators (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease study 2013. Lancet 385:117–171
    • View reference on publisher's website
  27. Mortensen LH, Rehnberg J, Dahl E, Diderichsen F, Elstad JI, Martikainen P, Rehkopf D, Tarkiainen L, Fritzell J (2016) Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003. BMJ Open 6:e010974
    • View reference on publisher's website
    • View reference on PubMed
  28. Adler NE, Ostrove JM (1999) Socioeconomic status and health: what we know and what we don’t. Ann New York Acad Sci 896:3–15
    • View reference on publisher's website
  29. Adler NE, Newman K (2002) Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood) 21:60–76
    • View reference on publisher's website
  30. Jolley RJ, Quan H, Jetté N, Sawka KJ, Diep L, Goliath J, Roberts DJ, Yipp BG, Doig CJ (2015) Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data. BMJ Open 5:e009487
    • View reference on publisher's website
    • View reference on PubMed
  31. Zheng RJ, Fu Y, Xiang QF, Yang M, Chen L, Shi YK, Yu CH, Li JY (2016) Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China. Support Care Cancer 24:4097–4103
    • View reference on publisher's website
    • View reference on PubMed
  32. Huang YC, Huang SJ, Ko WJ (2009) Going home to die from surgical intensive care units. Intensive Care Med 35:810–815
  33. Wang L, Yang G, Jiemin M, Rao C, Wan X, Dubrovsky G, Lopez AD (2007) Evaluation of the quality of cause of death statistics in rural China using verbal autopsies. J Epidemiol Community Health 61:519–526
    • View reference on publisher's website
    • View reference on PubMed
  34. Yang G, Rao C, Ma J, Wang L, Wan X, Dubrovsky G, Lopez AD (2006) Validation of verbal autopsy procedures for adult deaths in China. Int J Epidemiol 35:741–748
    • View reference on publisher's website
    • View reference on PubMed
  35. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. New Engl J Med 348:1546–1554
    • View reference on publisher's website
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement