Disparities in Sepsis Mortality by Region, Urbanization, and Race in the USA: a Multiple Cause of Death Analysis

  • Funmilola OgundipeEmail author
  • Vijay Kodadhala
  • Temitayo Ogundipe
  • Alem Mehari
  • Richard Gillum



To assess gender, race/ethnicity, and geographic disparities in sepsis-associated mortality.

Materials and Methods

The US data for multiple causes of death (MCOD) for years 2013–2016 were used to determine numbers of deaths and age-adjusted rates for sepsis as underlying or contributing cause of death using the International Classification of Diseases–10 (ICD-10) codes for non-Hispanic blacks (NHB) and whites (NHW) aged 15 years and older.


There were a total of 746,725 sepsis-associated deaths. Among females, age-adjusted death rate for NHB was 88.6 (95% CI 87.8–89.3) and for NHW, 55.4 (95% CI 55.1–55.6). Among males, age-adjusted death rate for NHB was 115.2 (95% CI 114.1–116.3) and for NHW, 69.5 (95% CI 69.2–69.8). Rates were generally higher in divisions of the south region (West South Central in NHB). Within the South, NHW and NHB who resided in non-metropolitan areas had the highest rates, while the lowest were in suburban metropolitan areas.


Sepsis-related MCOD mortality rates were highest in males, in NHB, in the South region, and, within the South, non-metropolitan areas.


Sepsis Septicemia Systemic inflammatory response syndrome Ethnic groups Race 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

40615_2018_553_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 23 kb)


  1. 1.
    Gül F, Arslantaş MK, Cinel İ, Kumar A. Changing definitions of sepsis. Turk J Anaesthesiol Reanim. 2017;45(3):129–38. Scholar
  2. 2.
    Melamed A, Sorvillo FJ. The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care. 2009;13(1):R28. Scholar
  3. 3.
    Barnato AE, Alexander SL, Linde-Zwirble WT, Angus DC. Racial variation in the incidence, care, and outcomes or severe sepsis: analysis of population, patient, and hospital characteristics. Am J Respir Crit Care Med. 2008;177:279–84.CrossRefPubMedGoogle Scholar
  4. 4.
    Richardus JH, Kunst AE. Black-white differences in infectious disease mortality in the United States. Am J Public Health. 2001;91(8):1251–3.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Moore JX, Donnelly JP, Griffin R, Safford MM, Howard G, Baddley J, et al. Black-white racial disparities in sepsis: a prospective analysis of the reasons for geographic and racial differences in stroke (REGARDS) cohort. Crit Care. 2015;19:279. Scholar
  6. 6.
    Sandoval E, Chang DW. Association between race and case fatality rate in hospitalizations for sepsis. J Racial Ethn Health Disparities. 2016;3(4):625–34.CrossRefPubMedGoogle Scholar
  7. 7.
    Chaudhary NS, Donnelly JP, Wang HE. Racial differences in sepsis mortality at U.S. Academic Medical Center-affiliated hospitals. Crit Care Med. 2018;46(6):878–83. Scholar
  8. 8.
    Shankar-Hari M, Rubenfeld G. Race, ethnicity, and sepsis: beyond adjusted odds ratios. Crit Care Med. 2018;46(6):1009–10.CrossRefPubMedGoogle Scholar
  9. 9.
    Elfeky S, Golabi P, Otgonsuren M, Djurkovic S, Schmidt ME, Younossi ZM. The epidemiologic characteristics, temporal trends, predictors of death, and discharge disposition in patients with a diagnosis of sepsis: a cross-sectional retrospective cohort study. J Crit Care. 2017;39:48–55. Scholar
  10. 10.
    Goodwin AJ, Nadig NR, McElligott JT, Simpson KN, Ford DW. Where you live matters: the impact of place of residence on severe sepsis incidence and mortality. Chest. 2016;150(4):829–36. Scholar
  11. 11.
    Galiatsatos P, Brigham EP, Pietri J, Littleton K, Hwang S, Grant MC, et al. The effect of community socioeconomic status on sepsis-attributable mortality. J Crit Care. 2018;46:129–33. Scholar
  12. 12.
    Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999–2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999–2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at on 21 Mar 2018 2:10:14 PM.
  13. 13.
    Ingram DD, Franco SJ. NCHS urban–rural classification scheme for counties. National Center for Health Statistics. Vital Health Stat. 2013;2(166):2014.Google Scholar
  14. 14.
    Mayr FB, Yende S, Linde-Zwirble WT, Peck-Palmer OM, Barnato AE, Weissfeld LA, et al. Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis. JAMA. 2010;303(24):2495–503. Scholar
  15. 15.
    Epstein L, Dantes R, Magill S, Fiore A. Varying estimates of sepsis mortality using death certificates and administrative codes--United States, 1999-2014. MMWR Morb Mortal Wkly Rep. 2016;65(13):342–5. Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Howard University HospitalWashingtonUSA
  2. 2.Howard University College of MedicineWashingtonUSA

Personalised recommendations