Multinational trends in sepsis mortality between 1985 and 2019: a temporal analysis of the WHO mortality database
File(s)
Published version
Author(s)
Komorowski, M
Salciccioli, J
Shalhoub, Joseph
Gordon, A
Marshall, D
Type
Journal Article
Abstract
Objectives
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 multi-national trend of sepsis-related mortality for the period 1985-2019 from the World Health Organization (WHO) Mortality Database.
Design
Retrospective analysis of the WHO Mortality Database.
Setting
We included data from all countries defined as having “high usability data” by the WHO, and at least 10 years of total available data.
Participants
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.
Primary and secondary outcome measures
We analysed Age-Standardised Death Rates (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).
Results
We included 1,104 country-years worth of data from 36 countries with high usability data, accounting for around 15% of the world’s population. The median ASDR 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 ASDR 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.
Conclusions
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.
Strengths and limitations
• We describe sepsis-related age-standardised death rates for the period 1985-2019 and 36 countries, using the WHO Mortality Database, and include most of Europe, Israel, Australia, New Zealand, South Korea, Japan, Canada and the USA.
• We used Joinpoint and locally weighted smoothing (LOESS) regression analysis to describe trends in Age-Standardised Death Rates.
• Mid-way through our analysis (in the year 2000), our data coverage represented about 15.7% of the world’s population (971 million out of 6.2 billion individuals).
• To limit the impact of changing sepsis definitions and ICD taxonomies, we have not restricted ICD codes to “sepsis” or “septicaemia”, but have also included the root causes of sepsis (such as pneumonia, peritonitis, etc.) following previously described definitions.
• This approach does not capture well low- and middle-income countries’ (LMICs)
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 multi-national trend of sepsis-related mortality for the period 1985-2019 from the World Health Organization (WHO) Mortality Database.
Design
Retrospective analysis of the WHO Mortality Database.
Setting
We included data from all countries defined as having “high usability data” by the WHO, and at least 10 years of total available data.
Participants
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.
Primary and secondary outcome measures
We analysed Age-Standardised Death Rates (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).
Results
We included 1,104 country-years worth of data from 36 countries with high usability data, accounting for around 15% of the world’s population. The median ASDR 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 ASDR 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.
Conclusions
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.
Strengths and limitations
• We describe sepsis-related age-standardised death rates for the period 1985-2019 and 36 countries, using the WHO Mortality Database, and include most of Europe, Israel, Australia, New Zealand, South Korea, Japan, Canada and the USA.
• We used Joinpoint and locally weighted smoothing (LOESS) regression analysis to describe trends in Age-Standardised Death Rates.
• Mid-way through our analysis (in the year 2000), our data coverage represented about 15.7% of the world’s population (971 million out of 6.2 billion individuals).
• To limit the impact of changing sepsis definitions and ICD taxonomies, we have not restricted ICD codes to “sepsis” or “septicaemia”, but have also included the root causes of sepsis (such as pneumonia, peritonitis, etc.) following previously described definitions.
• This approach does not capture well low- and middle-income countries’ (LMICs)
Date Issued
2024-09
Date Acceptance
2024-08-22
Citation
BMJ Open, 2024, 14 (9)
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Volume
14
Issue
9
Copyright Statement
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.
License URL
Identifier
https://bmjopen.bmj.com/content/14/9/e074822
Publication Status
Published
Article Number
e074822
Date Publish Online
2024-09-12