Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany – an ecological study
Abstract Background Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking. Methods Ecological study based on the nationwide hospital Diagnosis-rel...
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BMC
2021-09-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-021-11629-4 |
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| author | Norman Rose Claudia Matthäus-Krämer Daniel Schwarzkopf André Scherag Sebastian Born Konrad Reinhart Carolin Fleischmann-Struzek |
| author_facet | Norman Rose Claudia Matthäus-Krämer Daniel Schwarzkopf André Scherag Sebastian Born Konrad Reinhart Carolin Fleischmann-Struzek |
| author_sort | Norman Rose |
| collection | DOAJ |
| description | Abstract Background Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking. Methods Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions. Results In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts. Conclusions Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany. |
| first_indexed | 2024-12-16T14:34:16Z |
| format | Article |
| id | doaj.art-4e5207b134514b578bf9f7f673e62f0a |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-16T14:34:16Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-4e5207b134514b578bf9f7f673e62f0a2022-12-21T22:28:08ZengBMCBMC Public Health1471-24582021-09-0121111110.1186/s12889-021-11629-4Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany – an ecological studyNorman Rose0Claudia Matthäus-Krämer1Daniel Schwarzkopf2André Scherag3Sebastian Born4Konrad Reinhart5Carolin Fleischmann-Struzek6Center for Sepsis Control and Care, Jena University HospitalCenter for Sepsis Control and Care, Jena University HospitalInstitute of Infectious Diseases and Infection Control, Jena University HospitalInstitute of Medical Statistics, Computer and Data Sciences, Jena University HospitalCenter for Sepsis Control and Care, Jena University HospitalDepartment of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin BerlinCenter for Sepsis Control and Care, Jena University HospitalAbstract Background Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking. Methods Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions. Results In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts. Conclusions Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany.https://doi.org/10.1186/s12889-021-11629-4SepsisIncidenceEcological studySocioeconomic factorsMedical services |
| spellingShingle | Norman Rose Claudia Matthäus-Krämer Daniel Schwarzkopf André Scherag Sebastian Born Konrad Reinhart Carolin Fleischmann-Struzek Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany – an ecological study BMC Public Health Sepsis Incidence Ecological study Socioeconomic factors Medical services |
| title | Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany – an ecological study |
| title_full | Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany – an ecological study |
| title_fullStr | Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany – an ecological study |
| title_full_unstemmed | Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany – an ecological study |
| title_short | Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany – an ecological study |
| title_sort | association between sepsis incidence and regional socioeconomic deprivation and health care capacity in germany an ecological study |
| topic | Sepsis Incidence Ecological study Socioeconomic factors Medical services |
| url | https://doi.org/10.1186/s12889-021-11629-4 |
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