Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK.
Int J Equity Health. 2024 Feb 21;23(1):34. doi: 10.1186/s12939-024-02114-6.
Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around recognition and antibiotic treatment of sepsis, but did not consider factors relating to health inequalities. The aim of this study was to summarise the literature investigating associations between health inequalities and sepsis.
Searches were conducted in Embase for peer-reviewed articles published since 2010 that included sepsis in combination with one of the following five areas: socioeconomic status, race/ethnicity, community factors, medical needs and pregnancy/maternity.
Five searches identified 1,402 studies, with 50 unique studies included in the review after screening (13 sociodemographic, 14 race/ethnicity, 3 community, 3 care/medical needs and 20 pregnancy/maternity; 3 papers examined multiple health inequalities). Most of the studies were conducted in the USA (31/50), with only four studies using UK data (all pregnancy related). Socioeconomic factors associated with increased sepsis incidence included lower socioeconomic status, unemployment and lower education level, although findings were not consistent across studies. For ethnicity, mixed results were reported. Living in a medically underserved area or being resident in a nursing home increased risk of sepsis. Mortality rates after sepsis were found to be higher in people living in rural areas or in those discharged to skilled nursing facilities while associations with ethnicity were mixed. Complications during delivery, caesarean-section delivery, increased deprivation and black and other ethnic minority race were associated with post-partum sepsis.
There are clear correlations between sepsis morbidity and mortality and the presence of factors associated with health inequalities. To inform local guidance and drive public health measures, there is a need for studies conducted across more diverse setting and countries.
脓毒症是一种由感染引起的免疫反应失调导致的严重且危及生命的疾病。英国最近发布的指南针对脓毒症的识别和抗生素治疗提出了建议，但没有考虑与健康不平等相关的因素。本研究旨在总结调查健康不平等与脓毒症之间关联的文献。
在 Embase 中进行了检索，以查找自 2010 年以来发表的包含脓毒症并结合以下五个领域之一的同行评议文章：社会经济地位、种族/民族、社区因素、医疗需求和妊娠/分娩。
五次搜索共确定了 1402 项研究，经过筛选后有 50 项独特的研究纳入了综述（13 项社会人口统计学、14 项种族/民族、3 项社区、3 项医疗需求和 20 项妊娠/分娩；3 项研究调查了多种健康不平等）。大多数研究在美国进行（31/50），只有四项研究使用了英国数据（均与妊娠相关）。与脓毒症发病率增加相关的社会经济因素包括社会经济地位较低、失业和教育水平较低，但研究结果并不一致。关于种族，报告了混合结果。居住在医疗服务不足的地区或居住在疗养院会增加脓毒症的风险。脓毒症后死亡率在居住在农村地区或出院到熟练护理设施的人群中较高，而与种族的关联则存在差异。分娩期间的并发症、剖宫产分娩、贫困程度增加以及黑人及其他少数民族种族与产后脓毒症有关。
脓毒症发病率和死亡率与与健康不平等相关的因素之间存在明显关联。为了为当地指南提供信息并推动公共卫生措施，需要在更多不同的环境和国家开展研究。
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