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Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach.医院间转运与严重脓毒症和脓毒性休克患者死亡率增加及成本上升相关：一种工具变量法。
J Crit Care. 2016 Dec;36:187-194. doi: 10.1016/j.jcrc.2016.07.016. Epub 2016 Jul 26.
2
Where You Live Matters: The Impact of Place of Residence on Severe Sepsis Incidence and Mortality.你居住的地方很重要：居住地对严重脓毒症发病率和死亡率的影响。
Chest. 2016 Oct;150(4):829-836. doi: 10.1016/j.chest.2016.07.004. Epub 2016 Jul 19.
3
Validity of administrative data in recording sepsis: a systematic review.行政数据记录脓毒症的有效性：一项系统综述
Crit Care. 2015 Apr 6;19(1):139. doi: 10.1186/s13054-015-0847-3.
4
Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study.拯救脓毒症运动：一项为期7.5年的研究中绩效指标与结果之间的关联
Crit Care Med. 2015 Jan;43(1):3-12. doi: 10.1097/CCM.0000000000000723.
5
Guideline bundles adherence and mortality in severe sepsis and septic shock.严重脓毒症和感染性休克中指南集束的依从性与死亡率
Crit Care Med. 2014 Aug;42(8):1890-8. doi: 10.1097/CCM.0000000000000297.
6
Widening rural-urban disparities in life expectancy, U.S., 1969-2009.预期寿命城乡差距扩大，美国，1969-2009 年。
Am J Prev Med. 2014 Feb;46(2):e19-29. doi: 10.1016/j.amepre.2013.10.017.
7
Benchmarking the incidence and mortality of severe sepsis in the United States.美国严重脓毒症发病率和死亡率的基准研究。
Crit Care Med. 2013 May;41(5):1167-74. doi: 10.1097/CCM.0b013e31827c09f8.
8
Severe sepsis cohorts derived from claims-based strategies appear to be biased toward a more severely ill patient population.基于索赔策略得出的严重脓毒症队列似乎偏向于病情更严重的患者群体。
Crit Care Med. 2013 Apr;41(4):945-53. doi: 10.1097/CCM.0b013e31827466f1.
9
Quality of life in rural and urban adults 65 years and older: findings from the National Health and Nutrition Examination survey.农村和城市 65 岁及以上成年人的生活质量：来自国家健康和营养检查调查的结果。
J Rural Health. 2012 Fall;28(4):339-47. doi: 10.1111/j.1748-0361.2011.00403.x. Epub 2012 Feb 6.
10
All-cause and cause-specific mortality among US youth: socioeconomic and rural-urban disparities and international patterns.美国青年的全因和特定原因死亡率：社会经济和城乡差异以及国际模式。
J Urban Health. 2013 Jun;90(3):388-405. doi: 10.1007/s11524-012-9744-0.

严重脓毒症的临床和流行病学变异性：一项生态学研究。

Clinical and epidemiological variability in severe sepsis: an ecological study.

机构信息

Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.

Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.

出版信息

J Epidemiol Community Health. 2018 Aug;72(8):741-745. doi: 10.1136/jech-2018-210501. Epub 2018 Apr 10.

DOI:10.1136/jech-2018-210501
PMID:29636401
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7027349/
Abstract

BACKGROUND

To assess clinical and epidemiological trends of severe sepsis.

METHODS

Ecological study of patients presenting to the emergency department with severe sepsis or septic shock between 2005 and 2013. Patients were identified using the state-wide hospital administrative database. Key outcomes included incidence rates (IRs) and mortality rates (per 1000 population) by age and medically underserved areas (MUAs), sepsis case fatality rate (deaths per 100 sepsis cases), and proportions of transfer and comorbidities.

RESULTS

There were 154 019 sepsis cases identified. In 2005, 85+ yo in non-MUAs had a 44% increase in IR compared with those in MUAs, and this difference rose to 74% by 2013. Mortality rates were 1.6 (95% CI 1.3 to 1.8) times greater among 85+ yo in non-MUAs. Mortality rates increased by 1.8% annually, while the sepsis case fatality rate decreased by 7.7%. The proportion of transfer among sepsis cases decreased by 2.1% per year (3.8% in non-MUAs, 0.7% in MUAs).

CONCLUSIONS

Sepsis incidence varies geographically, and access to healthcare is one proposed mechanism that may explain heterogeneity. Over time, we may be capturing higher acuity sepsis cases with better recognition and management, as well as observing differential diagnostic coding documentation by location.

摘要

背景

评估严重脓毒症的临床和流行病学趋势。

方法

对 2005 年至 2013 年间在急诊科就诊的严重脓毒症或感染性休克患者进行的生态学研究。使用全州医院管理数据库来识别患者。主要结局包括按年龄和医疗服务不足地区（MUA）划分的发病率（IR）和死亡率（每千人人口）、脓毒症病死率（每 100 例脓毒症病例的死亡人数）以及转移比例和合并症。

结果

共确定了 154019 例脓毒症病例。2005 年，非 MUA 地区 85 岁以上人群的 IR 比 MUA 地区增加了 44%，到 2013 年，这一差异上升至 74%。非 MUA 地区 85 岁以上人群的死亡率高 1.6 倍（95%CI 1.3 至 1.8）。死亡率每年增加 1.8%，而脓毒症病死率则下降了 7.7%。脓毒症病例的转移比例每年下降 2.1%（非 MUA 地区为 3.8%，MUA 地区为 0.7%）。

结论

脓毒症的发病率存在地域差异，而获得医疗保健可能是造成这种异质性的一个原因。随着时间的推移，我们可能会通过更好的识别和管理来捕获更高危的脓毒症病例，同时也会观察到地理位置不同的诊断编码文件的差异。