Sepsis epidemiology in Australian Public Hospitals, a nationwide longitudinal study (2013-2018)

Abstract

Introduction: Sepsis is a life-threatening condition that contributes considerably to the global burden of disease in the population. This study aimed to determine the incidence and mortality of sepsis in Australian public hospitals and to investigate variations in sepsis incidence and mortality.Methods: Patients admitted to 739 Australian public hospitals from 2013-14 to 2017-18 were included in this study. Sepsis patients were identified based on the recorded diagnosis codes. Age standardised sepsis incidence and mortality rates were calculated. Generalised estimating equations were applied to examine changes in mortality rates over time.Results: Among 23,827,061 hospitalisations, 437,354 (1.8%) had a coded diagnosis of sepsis and 12.0% of these sepsis patients (n=52,297) died in hospital, which was 11 times higher than non-sepsis patients (1.1%). Overall age standardised sepsis incidence was 1,162.8 cases/100,000 population. Despite the increase in sepsis incidence over the study period, sepsis mortality rates remained relatively stable after adjusting for relevant risk factors and hospital clustering. The youngest patients experienced the highest sepsis incidence rate. Those living in very remote areas were hospitalised for sepsis at around 1.7 times the rate as those living in major cities. The sepsis incidence rate among Indigenous people was also 1.7 times higher than among other Australians.Conclusion: This is the first national study on hospitalisations and in-hospital deaths associated with sepsis across all Australian public hospitals. Despite an increase in awareness and clinical initiatives related to sepsis, it remains a significant health problem that affects certain groups in the population more than others. Introduction: Sepsis is a life-threatening condition that contributes considerably to the global burden of disease in the population. This study aimed to determine the incidence and mortality of sepsis in Australian public hospitals and to investigate variations in sepsis incidence and mortality. Methods: Patients admitted to 739 Australian public hospitals from 2013-14 to 2017-18 were included in this study. Sepsis patients were identified based on the recorded diagnosis codes. Age standardised sepsis incidence and mortality rates were calculated. Generalised estimating equations were applied to examine changes in mortality rates over time. Results: Among 23,827,061 hospitalisations, 437,354 (1.8%) had a coded diagnosis of sepsis and 12.0% of these sepsis patients (n=52,297) died in hospital, which was 11 times higher than non-sepsis patients (1.1%). Overall age standardised sepsis incidence was 1,162.8 cases/100,000 population. Despite the increase in sepsis incidence over the study period, sepsis mortality rates remained relatively stable after adjusting for relevant risk factors and hospital clustering. The youngest patients experienced the highest sepsis incidence rate. Those living in very remote areas were hospitalised for sepsis at around 1.7 times the rate as those living in major cities. The sepsis incidence rate among Indigenous people was also 1.7 times higher than among other Australians. Conclusion: This is the first national study on hospitalisations and in-hospital deaths associated with sepsis across all Australian public hospitals. Despite an increase in awareness and clinical initiatives related to sepsis, it remains a significant health problem that affects certain groups in the population more than others.