Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.
Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
BMC Public Health. 2021 Sep 7;21(1):1636. doi: 10.1186/s12889-021-11629-4.
Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking.
Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions.
In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts.
Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany.
脓毒症是一个重大的医疗保健负担。缺乏关于德国脓毒症发病率的区域差异的数据，以及任何与区域社会经济贫困和医疗保健能力相关的可能关联。
基于 2016 年全国医院诊断相关组（DRG）统计数据的生态研究。我们通过 ICD-10 编码确定了脓毒症，并计算了 401 个德国行政区的粗发病率和年龄标准化发病率。通过简单和多负二项式（NB）回归，研究了社会经济和医疗保健能力指标与粗发病率和年龄调整后脓毒症发病率之间的关联。
2016 年，脓毒症发病率为每 10 万人 178 例，各区之间差异高达 10 倍。我们发现，辍学生比例与简单和多 NB 回归中的粗发病率和年龄标准化明确脓毒症发病率显著相关。虽然我们没有发现与医院床位和全科医生能力相关的证据，但与最近的药店的距离与粗发病率和年龄标准化脓毒症发病率相关。在多回归分析中，距离增加 +1000 米与预期增加 21.6[95%置信区间，10.1，33.0]（p<0.001）和 11.1[95%置信区间，1.0，21.2]/100,000 人（p=0.026）相关，调整了各区之间的年龄差异。
居住在社会经济地位较低（例如，教育程度较低）的地区以及距离药店较远的地区，脓毒症发病率都较高。这需要进一步研究以个体患者数据为基础，以更好地建立和理解这种相关性，并最终设计公共卫生干预措施来解决德国脓毒症的负担。
