Risk Factors for Septicemia Deaths and Disparities in a Longitudinal US Cohort.

• Type of Material: Article
• Authors: Jordan Kempker, Emory University; Greg Martin, Emory University; Lance Waller, Emory University; Michael R Kramer, Emory University
• Language: English
• Date: 2018-12
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofy305
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 5
• Issue: 12
• Start Page: ofy305
• End Page: ofy305
• Grant/Funding Information: Financial support. During this work, Dr. Kempker received support from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Numbers UL1TR000454 and KL2 TR000455 and the Agency for Healthcare Research and Quality under Award Number K08HS025240.; Dr. Martin also received support from NIH UL1 TR000454.
• Keywords: sepsis; epidemiology; sepsis mortality
• Research Categories: Health Sciences, General; Health Sciences, Epidemiology

Abstract

Background: There are few longitudinal data on the risk factors and mediators of racial disparities in sepsis among community- dwelling US adults. Methods: This is a longitudinal study of adult participants in the 1999-2005 National Health Interview Survey with data linked to the 1999-2011 National Death Index. We utilized National Vital Statistics System's ICD-10 schema to define septicemia deaths (A40-A41), utilizing influenza and pneumonia deaths (J09-J11) and other causes of death as descriptive comparators. All statistics utilized survey design variables to approximate the US adult population. Results: Of 206 691 adult survey participants, 1523 experienced a septicemia death. Factors associated with a >2-fold larger hazard of septicemia death included need for help with activities of daily living; self-reported "poor" and "fair" general health; lower education; lower poverty index ratio; self-reported emphysema, liver condition, stroke, and weak or failing kidneys; numerous measures of disability; general health worse than the year prior; >1 pack per day cigarette use; and higher utilization of health care. Blacks had age- and sex-adjusted hazards that were higher for septicemia deaths (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.65-2.23) than for other causes of death (HR, 1.32; 95% CI, 1.25-1.38). The strongest mediators of the septicemia disparity included self-reported general health condition, family income-poverty ratio, and highest education level achieved. Conclusions: In this cohort, the major risk factors for septicemia death were similar to those for other causes of death, there was approximately a 2-fold black-white disparity in septicemia deaths, and the strongest mediators of this disparity were across domains of socioeconomic status.