Thao Dang, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
John Garza, PhD
Assistant Professor
University of Texas Permian Basin, United States
Disclosure information not submitted.
Neha Panchagnula
Texas Tech University Health Sciences Center at the Permian Basin
Odessa, Texas
Disclosure information not submitted.
Hina Tariq, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Lavi Oud, MD
Professor
Texas Tech University Health Sciences Center
Odessa, Texas, United States
Disclosure information not submitted.
Title: State-Level Variation in Temporal Trends of Sepsis Mortality in the United States, 2010-2019
Introduction: Recent death certificate-based data demonstrated decreasing sepsis-related mortality rates among Blacks, Hispanics, and Asians, but rising mortality rates among Native Americans and Whites in the United States. It is unclear whether these outcome trends were consistent across individual states.
Methods: We queried the CDC WONDER Multiple Cause of Death dataset for sepsis-related deaths during 2010-2019, using previously reported ICD-10-based taxonomy. Annual age-adjusted mortality rates were obtained for individual states and the District of Columbia (DC), except for states with number of deaths deemed by the CDC too low to estimate mortality rates. Negative binomial regression was used to model mortality trends by race and ethnicity. The results for each state were then examined for within-state concordance of the direction of mortality trends across race and ethnicity strata.
Results: Complete age-adjusted mortality rates for Blacks, Hispanics, Asians, Native Americans, and Whites were available for 40, 28, 21, 11, and 50 states (& DC), respectively. The state-level, sepsis-related mortality trend directions (number of states [%]) were: Blacks: unchanged in 22 [55%], increased in 6 [15%], decreased in 12 [30%]; Hispanics: unchanged in 20 [71.4%], increased in 5 [17.9%], decreased in 3 [10.7%]; Asians: unchanged in 14 [66.7%], increased in 1 [4.8%], decreased in 6 [28.6%]; Native Americans: unchanged in 7 [63.6%], increased in 3 [27.3%], decreased in 1 [9.1%]; Whites: unchanged in 11 [21.6%], increased in 34 [66.7%], decreased in 6 [11.8%]. Concordance of mortality trend direction across race and ethnicity strata occurred only in one state.
Conclusions: National-level gains in sepsis-related outcomes in the United States over the past decade were not shared equitably across individual states among racial and ethnic minorities. There was substantial state-level variation in the direction of sepsis-related mortality trends across all examined race and ethnicity groups. Within-state sepsis-related mortality trends generally diverged across race and ethnicity strata. Our findings can inform future state-level examination of patient, system, and process factors underlying the demonstrated disparities in sepsis outcomes, which can in turn guide future policy- and practice-focused efforts.