@article{f9b1a9a827a04030b5598445c12e0959,
title = "Community characteristics and regional variations in sepsis",
abstract = "Background: Sepsis may contribute to more than 200 000 annual deaths in the USA. Little is known about the regional patterns of sepsis mortality and the community characteristics that explain this relationship. We aimed to determine the influence of community characteristics upon regional variations in sepsis incidence and case fatality. Methods: We performed a retrospective analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Using US sepsis mortality data, we used two strategies for defining geographic regions: (i) Sepsis 'Belt' vs Non-Belt and (ii) Sepsis 'Cluster' vs Non-Cluster. We determined sepsis incidence and case fatality among REGARDS participants in each region, adjusting for participant characteristics. We examined the mediating effect of community characteristics upon regional variations in sepsis incidence and case fatality. Results: Among 29 680 participants, 16 493 (55.6%) resided in the Sepsis Belt and 2958 (10.0%) resided in a Sepsis Cluster. Sepsis incidence was higher for Sepsis Belt than Non-Belt participants [adjusted hazard ratio (HR)=1.14; 95% confidence interval (CI)=1.02-1.24] and higher for Sepsis Cluster than Non-Cluster participants (adjusted HR=1.18; 95% CI=1.01-1.39). Sepsis case fatality was similar between Sepsis Belt and Non-Belt participants, as well as between Cluster and Non-Cluster participants. Community poverty mediated the regional differences in sepsis incidence. Conclusions: Regional variations in sepsis incidence may be partly explained by community poverty. Other community characteristics do not explain regional variations in sepsis incidence or case fatality.",
keywords = "Epidemiology, Mediation analysis, Poverty, Region, Sepsis",
author = "Moore, {Justin Xavier} and Donnelly, {John P.} and Russell Griffin and Safford, {Monika M.} and George Howard and John Baddley and Wang, {Henry E.}",
note = "Funding Information: This work was supported by award grant number R01-NR012726 from the National Institute for Nursing Research, grant number UL1-RR025777 from the National Center for Research Resources, as well as by grants from the Center for Clinical and Translational Science and the Lister Hill Center for Health Policy of the University of Alabama at Birmingham. The parent REGARDS study was supported by cooperative agreement (grant number U01-NS041588) Funding Information: from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Mr Donnelly received support from the Agency for Healthcare Research and Quality, Rockville, MD (grant number T32-HS013852) and National Institutes of General Medical Sciences, NIH (grant number F31-GM122180). Mr Moore received grant support from the Cancer Prevention and Control Training Program (grant R25 CA47888), funded by the National Cancer Institute, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Funding Information: of interest: Amgen—salary support to study patterns of statin use in Medicare and other large databases; diaDexus—salary support for a research grant on lipids and CHD outcomes; diaDexus—consulting to help with FDA application; NIH, AHRQ—salary support for research grants. Mr Moore, Mr Donnelly and Drs Griffin, Wang, Howard and Baddley do not report any related conflicts of interest. Publisher Copyright: {\textcopyright} The Author 2017; Published by Oxford University Press on behalf of the International Epidemiological Association. All rights reserved.",
year = "2017",
month = oct,
doi = "10.1093/IJE/DYX099",
language = "English (US)",
volume = "46",
pages = "1607--1617",
journal = "International Journal of Epidemiology",
issn = "0300-5771",
publisher = "Oxford University Press",
number = "5",
}