社区特征和脓毒症的区域差异。
Community characteristics and regional variations in sepsis.
机构信息
Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
Int J Epidemiol. 2017 Oct 1;46(5):1607-1617. doi: 10.1093/ije/dyx099.
BACKGROUND
Sepsis may contribute to more than 200 000 annual deaths in the USA. Little is known about the regional patterns of sepsis mortality and the community characteristics that explain this relationship. We aimed to determine the influence of community characteristics upon regional variations in sepsis incidence and case fatality.
METHODS
We performed a retrospective analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Using US sepsis mortality data, we used two strategies for defining geographic regions: (i) Sepsis 'Belt' vs Non-Belt and (ii) Sepsis 'Cluster' vs Non-Cluster. We determined sepsis incidence and case fatality among REGARDS participants in each region, adjusting for participant characteristics. We examined the mediating effect of community characteristics upon regional variations in sepsis incidence and case fatality.
RESULTS
Among 29 680 participants, 16 493 (55.6%) resided in the Sepsis Belt and 2958 (10.0%) resided in a Sepsis Cluster. Sepsis incidence was higher for Sepsis Belt than Non-Belt participants [adjusted hazard ratio (HR) = 1.14; 95% confidence interval (CI) = 1.02-1.24] and higher for Sepsis Cluster than Non-Cluster participants (adjusted HR = 1.18; 95% CI = 1.01-1.39). Sepsis case fatality was similar between Sepsis Belt and Non-Belt participants, as well as between Cluster and Non-Cluster participants. Community poverty mediated the regional differences in sepsis incidence.
CONCLUSIONS
Regional variations in sepsis incidence may be partly explained by community poverty. Other community characteristics do not explain regional variations in sepsis incidence or case fatality.
背景
在美国，每年有超过 20 万人死于败血症。关于败血症死亡率的区域模式以及解释这种关系的社区特征，人们知之甚少。我们旨在确定社区特征对败血症发病率和病死率区域性差异的影响。
方法
我们对 REasons for Geographic and Racial Differences in Stroke（REGARDS）队列的数据进行了回顾性分析。使用美国败血症死亡率数据，我们使用了两种策略来定义地理区域：（i）败血症“带”与非“带”和（ii）败血症“群”与非“群”。我们在每个区域调整参与者特征后，确定 REGARDS 参与者中的败血症发病率和病死率。我们检查了社区特征对败血症发病率和病死率区域性差异的中介作用。
结果
在 29680 名参与者中，16493 名（55.6%）居住在败血症带，2958 名（10.0%）居住在败血症群。败血症带参与者的败血症发病率高于非“带”参与者[调整后的危险比（HR）=1.14；95%置信区间（CI）=1.02-1.24]，败血症群参与者的败血症发病率高于非“群”参与者（调整后的 HR=1.18；95% CI=1.01-1.39）。败血症带和非“带”参与者之间以及败血症群和非“群”参与者之间的败血症病死率相似。社区贫困程度部分解释了败血症发病率的区域性差异。
结论
败血症发病率的区域性差异可能部分归因于社区贫困。其他社区特征不能解释败血症发病率或病死率的区域性差异。
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