Division of Pulmonary and Critical Care Medicine, Box 359762, Harborview Medical Center, Seattle, WA 98104, USA.
Chest. 2010 Jun;137(6):1289-96. doi: 10.1378/chest.09-2661. Epub 2010 Feb 19.
Sepsis is a major public health problem. Social factors may affect health behaviors, economic resources, and immune response, leading to hospitalization for infection. This study examines the association between marital status and sepsis incidence and outcomes in a population-based cohort.
We analyzed 1,113,581 hospitalizations in New Jersey in 2006. We estimated risk-adjusted incidence rate ratios (IRRs) for sepsis among divorced, widowed, legally separated, single, and married subjects using population data from the American Community Survey. We used multivariable logistic regression to estimate marital status-specific hospital mortality.
We identified 37,524 hospitalizations for sepsis, of which 40% were among married (14,924), 7% were among divorced (2,548), 26% were among widowed (9,934), 2% (763) were among legally separated, and 26% (9355) were among single subjects. The incidence of hospitalization for sepsis was 5.8 per 1,000 population. The age, sex, and race-adjusted IRR for hospitalization with sepsis was greatest for single (IRR = 3.47; 95% CI, 3.1, 3.9), widowed (IRR = 1.38; 95% CI, 1.2, 1.6), and legally separated (IRR = 1.46; 95% CI, 1.2, 1.8) subjects compared with married (referent). We observed that single men and women and divorced men had greater odds of in-hospital mortality compared with married men; widowed and legally separated men and all ever-married women had no excess mortality during hospitalization for sepsis.
Hospitalization for sepsis is more common among single, widowed, and legally separated individuals, independent of other demographic factors. Among patients hospitalized for sepsis, single and divorced men and single women experience greater hospital mortality, highlighting the need to characterize the potentially modifiable mechanisms linking marital status to its greater burden of critical illness.
败血症是一个主要的公共卫生问题。社会因素可能会影响健康行为、经济资源和免疫反应，导致感染住院。本研究在基于人群的队列中研究了婚姻状况与败血症发病率和结局的关系。
我们分析了 2006 年新泽西州的 1113581 例住院患者。我们使用美国社区调查的人口数据，估计了离婚、丧偶、合法分居、单身和已婚患者中败血症的风险调整发病率比（IRR）。我们使用多变量逻辑回归来估计特定婚姻状况的住院死亡率。
我们确定了 37524 例败血症住院患者，其中 40%为已婚（14924 例），7%为离婚（2548 例），26%为丧偶（9934 例），2%为合法分居（763 例），26%为单身（9355 例）。败血症住院的发病率为每 1000 人 5.8 例。经年龄、性别和种族调整后，败血症住院的调整发病率比最高的是单身（IRR=3.47；95%CI，3.1，3.9）、丧偶（IRR=1.38；95%CI，1.2，1.6）和合法分居（IRR=1.46；95%CI，1.2，1.8）患者，而非已婚（参考）患者。我们发现，与已婚男性相比，单身男性和女性以及离婚男性在败血症住院期间的死亡风险更高；丧偶和合法分居的男性以及所有已婚女性在败血症住院期间没有额外的死亡。
单身、丧偶和合法分居的个体败血症住院更为常见，独立于其他人口统计学因素。在因败血症住院的患者中，单身和离婚男性以及单身女性的住院死亡率更高，这突出表明需要描述可能改变的机制，将婚姻状况与更严重的重病负担联系起来。
