Department of Surgery and Cancer, Imperial College London, London, UK
Imperial College Healthcare NHS Trust, London, UK.
BMJ Open. 2024 Sep 12;14(9):e074822. doi: 10.1136/bmjopen-2023-074822.
Understanding the burden of disease of sepsis is essential for monitoring the effectiveness of international strategies to improve sepsis care. Our objective was to describe the multinational trend of sepsis-related mortality for the period 1985-2019 from the WHO Mortality Database.
Retrospective analysis of the WHO Mortality Database.
We included data from all countries defined by the WHO as having 'high usability data' and at least 10 years of total available data.
From the WHO list of 50 countries with high usability data, 14 (28%) were excluded due to excessive missingness. We included and analysed data separately for male and female.
We analysed age-standardised mortality rates (ASMR) (weighted average of the age-specific mortality rates per 100 000 people, where the weights are the proportions of people in the corresponding age groups of the WHO standard population).
We included 1104 country-years worth of data from 36 countries with high usability data, accounting for around 15% of the world's population. The median ASMR for men decreased from 37.8 deaths/100 000 (IQR 28.4-46.7) in 1985-1987 to 25.8 deaths/100 000 (IQR 19.2-37) in 2017-2019, an approximately 12% absolute (31.8% relative) decrease. For women, the overall ASMR decreased from 22.9 deaths/100 000 (IQR 17.7-32.2) to 16.2 deaths/100 000 (IQR 12.6-21.6), an approximately 6.7% absolute decrease (29.3% relative decrease). The analysis of country-level data revealed wide variations in estimates and trends.
We observed a decrease in reported sepsis-related mortality across the majority of analysed nations between 1985 and 2019. However, significant variability remains between gender and health systems. System-level and population-level factors may contribute to these differences, and additional investigations are necessary to further explain these trends.
了解脓毒症的疾病负担对于监测改善脓毒症治疗的国际策略的有效性至关重要。我们的目的是描述 1985 年至 2019 年期间，来自世卫组织死亡率数据库的与脓毒症相关的死亡率的跨国趋势。
世卫组织死亡率数据库的回顾性分析。
我们纳入了世卫组织定义的“高可用性数据”的所有国家的数据，且这些国家至少有 10 年的总可用数据。
在世卫组织的 50 个高可用性数据国家名单中，有 14 个（28%）因缺失数据过多而被排除。我们分别对男性和女性的数据进行了分析。
我们分析了年龄标准化死亡率（ASMRS）（每 100000 人年龄特异性死亡率的加权平均值，权重为相应年龄组的世卫组织标准人口比例）。
我们纳入了来自 36 个高可用性数据国家的 1104 个国家/年的数据，这些国家的人口约占世界人口的 15%。男性的中位 ASMR 从 1985-1987 年的 37.8 例/100000（IQR 28.4-46.7）降至 2017-2019 年的 25.8 例/100000（IQR 19.2-37），绝对下降约 12%（相对下降 31.8%）。对于女性，整体 ASMR 从 22.9 例/100000（IQR 17.7-32.2）降至 16.2 例/100000（IQR 12.6-21.6），绝对下降约 6.7%（相对下降 29.3%）。对国家级数据的分析显示，估计值和趋势存在很大差异。
我们观察到，在 1985 年至 2019 年期间，大多数分析国家的与脓毒症相关的死亡率有所下降。然而，性别和卫生系统之间仍然存在显著差异。系统层面和人群层面的因素可能导致了这些差异，需要进一步的研究来进一步解释这些趋势。
