Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany.
Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany.
Int J Environ Res Public Health. 2023 May 18;20(10):5867. doi: 10.3390/ijerph20105867.
We aimed to examine urban-rural disparities in sepsis case fatality rates among patients with community-acquired sepsis in Germany.
Retrospective cohort study using de-identified data of the nationwide statutory health insurance AOK, covering approx. 30% of the German population. We compared in-hospital- and 12-month case fatality between rural and urban sepsis patients. We calculated odds ratios (OR) with 95% confidence intervals and the estimated adjusted odds ratio (OR) using logistic regression models to account for potential differences in the distribution of age, comorbidities, and sepsis characteristics between rural and urban citizens.
We identified 118,893 hospitalized patients with community-acquired sepsis in 2013-2014 with direct hospital admittance. Sepsis patients from rural areas had lower in-hospital case fatality rates compared to their urban counterparts (23.7% vs. 25.5%, < 0.001, Odds Ratio (OR) = 0.91 (95% CI 0.88, 0.94), OR = 0.89 (95% CI 0.86, 0.92)). Similar differences were observable for 12-month case fatalities (45.8% rural vs. 47.0% urban 12-month case fatality, < 0.001, OR = 0.95 (95% CI 0.93, 0.98), OR = 0.92 (95% CI 0.89, 0.94)). Survival benefits were also observable in rural patients with severe community-acquired sepsis or patients admitted as emergencies. Rural patients of <40 years had half the odds of dying in hospital compared to urban patients in this age bracket (OR = 0.49 (95% CI 0.23, 0.75), = 0.002).
Rural residence is associated with short- and long-term survival benefits in patients with community-acquired sepsis. Further research on patient, community, and health-care system factors is needed to understand the causative mechanisms of these disparities.
本研究旨在探讨德国社区获得性脓毒症患者的城乡病死率差异。
本研究采用全国法定健康保险 AOK 的匿名数据进行回顾性队列研究，该保险覆盖了德国约 30%的人口。我们比较了农村和城市社区获得性脓毒症患者的住院病死率和 12 个月病死率。我们计算了比值比（OR）及其 95%置信区间，并使用逻辑回归模型计算了调整后的比值比（OR），以考虑农村和城市居民在年龄、合并症和脓毒症特征分布方面的潜在差异。
我们在 2013 年至 2014 年期间确定了 118893 例直接住院的社区获得性脓毒症住院患者。与城市患者相比，农村地区的脓毒症患者的住院病死率较低（23.7%比 25.5%，<0.001，比值比（OR）=0.91（95%置信区间 0.88，0.94），OR=0.89（95%置信区间 0.86，0.92））。12 个月病死率也存在类似的差异（农村地区为 45.8%，城市地区为 47.0%，<0.001，OR=0.95（95%置信区间 0.93，0.98），OR=0.92（95%置信区间 0.89，0.94）））。在严重社区获得性脓毒症或紧急入院的农村患者中也观察到生存获益。<40 岁的农村患者的住院死亡风险比同年龄段的城市患者低一半（OR=0.49（95%置信区间 0.23，0.75），P=0.002））。
农村居民在社区获得性脓毒症患者中具有短期和长期生存获益。需要进一步研究患者、社区和医疗保健系统因素，以了解这些差异的因果机制。
