Skip to main content

Advertisement

SpringerLink
Log in

Sepsis-related mortality in China: a descriptive analysis

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

A population-level description and analysis of sepsis-related mortality in China is key to the planning and assessment of interventional strategies.

Methods

Retrospective analysis of multiple cause of death (MCOD) recorded in the population-based national mortality surveillance system (NMSS) of China. All sepsis-related deaths occurring in 605 disease surveillance points (DSPs) covering 323.8 million population across China were included in our study. Age-standardized mortality and national estimate of sepsis-related deaths were estimated using the census population in 2010 and 2015, respectively.

Results

In 2015, a total of 1,937,299 deaths occurring in any of the 605 DSPs and standardized sepsis-related mortality rate was 66.7 (95% confidence interval [CI] 66.4–67.0) deaths per 100,000 population. This produced a national estimate of 1,025,997 sepsis-related deaths. Sepsis-related mortality rates exhibited significant geographic variation. In multilevel analysis, male sex (rate ratio [RR] 1.582, 95% CI 1.570–1.595), increasing age (RR 1.914 for 5-year group, 95% CI 1.910–1.917), and presence of comorbidity (RR 2.316, 95% CI 2.298–2.335) were independently associated with increased sepsis-related mortality. Higher disposable income (RR 0.717 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.515–0.978) and mean years of education (RR 0.808 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.684–0.955) were negatively associated with sepsis-related mortality. However, population-based hospital doctors were not significantly associated with sepsis-related mortality.

Conclusions

The standardized sepsis-related mortality rate in China was high and varied according to socioeconomic indices, even though some uncertainty remained.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Reference

  1. Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, Iwashyna TJ (2014) Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 312:90–92

    Article  PubMed  CAS  Google Scholar 

  2. Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, Angus DC, Reinhart K, International Forum of Acute Care Trialists (2016) Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med 193:259–272

    Article  PubMed  CAS  Google Scholar 

  3. Finfer S, Machado FR (2016) The global epidemiology of sepsis. Does it matter that we know so little? Am J Respir Crit Care Med 193:228–230

    Article  PubMed  CAS  Google Scholar 

  4. Cheng B, Xie G, Yao S, Wu X, Guo Q, Gu M, Fang Q, Xu Q, Wang D, Jin Y, Yuan S, Wang J, Du Z, Sun Y, Fang X (2007) Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Crit Care Med 35:2538–2546

    Article  PubMed  Google Scholar 

  5. Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, Ai Y, Xu Y, Liu D, An Y, Wu D, Sun R, Li S, Hu Z, Cao X, Zhou F, Jiang L, Lin J, Mao E, Qin T, He Z, Zhou L, Du B, China Critical Care Clinical Trials Group (2014) Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS One 9:e107181

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Zhou J, Tian H, Du X, Xi X, An Y, Duan M, Weng L, Du B, China Critical Care Clinical Trials Group (CCCCTG) (2017) Population-based epidemiology of sepsis in a subdistrict of Beijing. Crit Care Med 45:1168–1176

    Article  PubMed  Google Scholar 

  7. Fedeli U, Piccinni P, Schievano E, Saugo M, Pellizzer G (2016) Growing burden of sepsis-related mortality in northeastern Italy: a multiple causes of death analysis. BMC Infect Dis 16:330

    Article  PubMed  PubMed Central  Google Scholar 

  8. Taniguchi LU, Bierrenbach AL, Toscano CM, Schettino GPP, Azevedo LCP (2014) Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010. Crit Care 18:608

    Article  PubMed  PubMed Central  Google Scholar 

  9. McPherson D, Griffiths C, Williams M, Baker A, Klodawski E, Jacobson B, Donaldson L (2013) Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open 3:e002586

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wang HE, Devereaux RS, Yealy DM, Safford MM, Howard G (2010) National variation in United States sepsis mortality: a descriptive study. Int J Health Geogr 9:9

    Article  PubMed  PubMed Central  Google Scholar 

  11. Melamed A, Sorvillo FJ (2009) The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care 13:R28

    Article  PubMed  PubMed Central  Google Scholar 

  12. Liu S, Wu X, Lopez AD, Wang L, Cai Y, Page A, Yin P, Liu Y, Li Y, Liu J, You J, Zhou M (2016) An integrated national mortality surveillance system for death registration and mortality surveillance, China. Bull World Health Organ 94:46–57

    Article  PubMed  Google Scholar 

  13. National Health and Family Planning Commission of the People’s Republic of China. Standard certificate of death in China. http://www.moh.gov.cn/ewebeditor/uploadfile/2014/01/20140113134120237.xls. Accessed 19 February 2018

  14. Centers for Disease Control and Prevention. Standard certificate of death in US. https://www.cdc.gov/nchs/data/dvs/blue_form.pdf. Accessed 19 February 2018

  15. World Health Organization. Strengthening civil registration and vital statistics for births, deaths and causes of death: resource kit. http://apps.who.int/iris/bitstream/10665/78917/1/9789241504591_eng.pdf. Accessed 19 February 2018

  16. World Health Organization. Improving mortality statistics through civil registration and vital statistics systems: strategies for country and partner support. http://www.who.int/healthinfo/civil_registration/CRVS_MortalityStats_Guidance_Nov2014.pdf. Accessed 19 February 2018

  17. Guo K, Yin P, Wang L, Ji Y, Li Q, Bishai D, Liu S, Liu Y, Astell-Burt T, Feng X, You J, Liu J, Zhou M (2015) Propensity score weighting for addressing under-reporting in mortality surveillance: a proof-of-concept study using the nationally representative mortality data in China. Popul Health Metr 13:16

    Article  PubMed  PubMed Central  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  19. Population census office under the state council and department of population and employment statistics of National Bureau of Statistics. Tabulation on the 2010 population census of People’s Republic of China. http://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm. Accessed 19 February 2018

  20. National Bureau of Statistics of China. China statistical yearbook 2015. http://www.stats.gov.cn/tjsj/ndsj/2015/indexeh.htm. Accessed 19 February 2018

  21. 2015 Year book of health and family planning in the People’s Republic of China. National Health and Family Planning Commission of the People’s Republic of China, Beijing, China

  22. National Bureau of Statistics of China. Statistical communiqué of the People’s Republic of China on the 2015 National Economic and Social Development. http://www.stats.gov.cn/english/PressRelease/201602/t20160229_1324019.html. Accessed 19 February 2018

  23. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RMH, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655

    Article  PubMed  CAS  Google Scholar 

  24. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

    Article  PubMed  CAS  Google Scholar 

  25. Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK (2012) Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003–2007. Crit Care Med 40:754–761

    Article  PubMed  Google Scholar 

  26. GBD 2013 Mortality and Causes of Death Collaborators (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease study 2013. Lancet 385:117–171

    Article  Google Scholar 

  27. Mortensen LH, Rehnberg J, Dahl E, Diderichsen F, Elstad JI, Martikainen P, Rehkopf D, Tarkiainen L, Fritzell J (2016) Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003. BMJ Open 6:e010974

    Article  PubMed  PubMed Central  Google Scholar 

  28. Adler NE, Ostrove JM (1999) Socioeconomic status and health: what we know and what we don’t. Ann New York Acad Sci 896:3–15

    Article  CAS  Google Scholar 

  29. Adler NE, Newman K (2002) Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood) 21:60–76

    Article  Google Scholar 

  30. Jolley RJ, Quan H, Jetté N, Sawka KJ, Diep L, Goliath J, Roberts DJ, Yipp BG, Doig CJ (2015) Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data. BMJ Open 5:e009487

    Article  PubMed  PubMed Central  Google Scholar 

  31. Zheng RJ, Fu Y, Xiang QF, Yang M, Chen L, Shi YK, Yu CH, Li JY (2016) Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China. Support Care Cancer 24:4097–4103

    Article  PubMed  PubMed Central  Google Scholar 

  32. Huang YC, Huang SJ, Ko WJ (2009) Going home to die from surgical intensive care units. Intensive Care Med 35:810–815

    Article  PubMed  Google Scholar 

  33. Wang L, Yang G, Jiemin M, Rao C, Wan X, Dubrovsky G, Lopez AD (2007) Evaluation of the quality of cause of death statistics in rural China using verbal autopsies. J Epidemiol Community Health 61:519–526

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yang G, Rao C, Ma J, Wang L, Wan X, Dubrovsky G, Lopez AD (2006) Validation of verbal autopsy procedures for adult deaths in China. Int J Epidemiol 35:741–748

    Article  PubMed  Google Scholar 

  35. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. New Engl J Med 348:1546–1554

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the support from national science and technology supporting plan (2012BAI11B00) of Ministry of Science and Technology of People’s Republic of China, and CAMS Innovation Fund for Medical Sciences (CIFMS) 2016-I2 M-1-014 from Chinese Academy of Medical Sciences.

Members of the CCCCTG Group: Ming-yan Zhao and Song-lin Yang(Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China); Xiao-chun Ma and Yi-ni Sun (Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China);Yong-jie Yin and De-xin Liu(Department of Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China); Zhen-jie Hu and Yan Huo (Department of Critical Care Medicine, Hebei Medical University Fourth Hospital, Shijiazhuang, China); Li Jiang and Qi Zhang (Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China); You-zhong An and Hui-ying Zhao (Department of Critical Care Medicine, Peking University People’s Hospital, Beijing, China); Tong Li and Wei He (Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China); Da-wei Wu and Chen Li (Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China); En-qiang Mao and Cheng Zhu (Emergency Intensive Care Unit, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China); Tie-he Qin and Shou-hong Wang (Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong, China); Rongqing Sun and Yue-xia Li (Surgical Intensive Care Unit, The First Affiliated Hospital, Zhengzhou University, Henan, China); Yu-hang Ai and Yin Huang (Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China); Jian-dong Lin and Xiong-jian Xiao (Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fujian, China); Zhen-yang He and Rui Li (Department of Critical Care Medicine, Hainan Provincial People’s Hospital, Hainan, China); Yan Kang and Xue-lian Liao (Department of Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China); Shu-sheng Li and Xiao Ran (Department of Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China); Xiang-you Yu and Yi Wang (Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, Xinjiang, China); Li-hua Zhou and Li-peng Zhang (Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China); Xi-jing Zhang and Bin-xiao Su (Surgical Intensive Care Unit, Xijing Hospital, Fourth Military Medical University, Xian, China); Fa-chun Zhou and Fang Xu (Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China); Ren-hua Su and Qian Li (Department of Critical Care Medicine, Zhejiang Provincial People’s Hospital, Zhejiang, China); Chuan-yun Qian and Wei Zhang (Department of Emergency Medicine and Emergency/Medical ICU, The First Affiliated Hospital of Kunming Medical University, Kunming, China); Xiang-yuan Cao and Xi-gang Ma (Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia, China); Qing-yuan Zhan and Xu Huang (Medical Intensive Care Unit, Department of Pulmonology, China-Japan Friendship Hospital, Beijing, China); Ming Hou (Emergency Intensive Care Unit, Qinghai University Affiliated Hospital, Qinghai, China); Bin Du, Li Weng and Xiao-yun Hu (Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China)

Author information

Authors and Affiliations

  1. Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, China

    Li Weng, Chun-yao Wang, Wei Jiang & Bin Du

  2. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China

    Xin-ying Zeng, Peng Yin, Li-jun Wang & Mai-geng Zhou

Authors
  1. Li Weng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xin-ying Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peng Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li-jun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chun-yao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mai-geng Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bin Du
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the China Critical Care Clinical Trials Group (CCCCTG)

  • Ming-yan Zhao
  • , Song-lin Yang
  • , Xiao-chun Ma
  • , Yi-ni Sun
  • , Yong-jie Yin
  • , De-xin Liu
  • , Zhen-jie Hu
  • , Yan Huo
  • , Li Jiang
  • , Qi Zhang
  • , You-zhong An
  • , Huiying Zha
  • , Tong Li
  • , Wei He
  • , Da-wei Wu
  • , Chen Li
  • , En-qiang Mao
  • , Cheng Zhu
  • , Tie-he Qin
  • , Shou-hong Wang
  • , Rongqing Sun
  • , Yue-xia Li
  • , Yu-hang Ai
  • , Yin Huang
  • , Jian-dong Lin
  • , Xiong-jian Xiao
  • , Zhen-yang He
  • , Rui Li
  • , Yan Kang
  • , Xue-lian Liao
  • , Shu sheng Li
  • , Xiao Ran
  • , Xiang-you Yu
  • , Yi Wang
  • , Li-hua Zhou
  • , Li-peng Zhang
  • , Xi-jing Zhang
  • , Bin-xiao Su
  • , Fa-chun Zhou
  • , Fang Xu
  • , Ren-hua Su
  • , Qian Li
  • , Chuan-yun Qian
  • , Wei Zhang
  • , Xiang-yuan Cao
  • , Xi-gang Ma
  • , Qing-yuan Zhan
  • , Xu Huang
  • , Ming Hou
  • , Bin Du
  • , Li Weng
  •  & Xiao-yun Hu

Contributions

LW, XYZ, PY, MGZ, and BD designed the study and invited researchers to participate in the study. XYZ, PY, and LW performed statistical analysis. LW, XYZ, PY, LJW, CYW, WJ, MGZ, and BD wrote and edited the manuscript.

Corresponding authors

Correspondence to Mai-geng Zhou or Bin Du.

Ethics declarations

Conflicts of interest

All authors report no conflicts of interest relevant to this article.

Additional information

Li Weng, Xin-ying Zeng, and Peng Yin contributed equally to the work.

The members of CCCCTG Group are listed in the Acknowledgements section.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 133 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weng, L., Zeng, Xy., Yin, P. et al. Sepsis-related mortality in China: a descriptive analysis. Intensive Care Med 44, 1071–1080 (2018). https://doi.org/10.1007/s00134-018-5203-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-018-5203-z

Keywords

Search

Navigation