Web of Causality: Sepsis
Mortality in Philadelphia
Melissa Lester
Dr. Matt Wray
Department of Sociology
Temple University
Philadelphia, PA
What is Sepsis?
• Bacteria or fungus enter
bloodstream2
• Community or hospital
acquired3
• Response by innate
immune system to
infections4
– Release cytokines
– Blood vessel dilation and
Clots
– Organ Impairment
– Organ Failure
• Treatment
– Antibiotics, oxygen, and
fluids
5
An Open Inquiry
• Exploring an obscure trend
– Sepsis mortality
• 2nd highest rate of large cities
– Philadelphia
• Leads to several questions
– Medical factors
– Social factors
• Place
• Aim to solve puzzle of high mortality rate
Sepsis Mortality by the Numbers
• Databases with mortality
figures
– WISQARS
– WONDER
• 10th leading cause of
death in the U.S.
• Low sepsis awareness
– International survey
• 22% have heard of the
term1
10 Leading Causes of Death, United States
2000 - 2007, All Races, Both Sexes
Background Literature
Undiagnosed
HIV6
HIV2,8
Trauma2,4,12
Lung
Cancer2,7
Inaccessible
Healthcare7
Smoking11
Sepsis
Recreational
Drug Use4
Malnutrition10
Alcohol
Abuse7,9
ICU
Admission3
Diabetes2,7
Inactivity10
Background Literature
Recreational
Drug Use4
Store Policy for Selling
Syringes13
Policies for HIV
Testing14
Sepsis
Social
Disorder15
Undiagnosed
HIV6
• Risk factors influenced by
– Municipal Laws
– Social Environment
– Physical Environment
Community Organizations
for Prevention of Drug
Use16
Shooting
Galleries17
How to Measure Sepsis Mortality?
• ICD-10
• Septicaemia codes18
– A40-A41
• Reliability
– Wang et al19: wider
definition for
research
• Death by infection
A40 Streptococcal septicaemia
Excludes: during labour ( O75.3 )
following:
· abortion or ectopic or molar pregnancy ( O03-O07 ,
O08.0 )
· immunization ( T88.0 )
· infusion, transfusion or therapeutic injection ( T80.2
)
neonatal ( P36.0-P36.1 )
postprocedural ( T81.4 )
puerperal ( O85 )
A40.0 Septicaemia due to streptococcus, group A
A40.1 Septicaemia due to streptococcus, group B
A40.2 Septicaemia due to streptococcus, group D
A40.3 Septicaemia due to Streptococcus pneumoniae
Pneumococcal septicaemia
A40.8 Other streptococcal septicaemia
A40.9 Streptococcal septicaemia, unspecified
Comparing Sepsis Mortality Rates
• Rank large cities
– Septicemia A40-A41
– Codes of Wang et al
• Compare Philadelphia to large cities with low and
high sepsis mortality
• Three cities:
– Baltimore 1st
– Philadelphia 2nd
– San Francisco 62nd
Deconstructing the Numbers
• Complied data for three variables
– Race
– Age
– Sex
• Compared rates between the three cities
Race
Asian or Pacific
Islander
Black or African
American
White
Race Code Deaths Population Crude Rate Age Adjusted Rate
A-PI
2054-5
2106-3
65
637031
10.2
19.9
2141
2249
5360450
5746689
39.9
39.1
45.7
28.8
Sepsis Mortality in terms of Race in Philadelphia20
Age Adjusted Rate of Sepsis Mortality by Race
50
45
40
Age Adjusted Rate
35
30
Philadelphia
Baltimore
San Francisco
25
20
15
10
5
0
Asian or Pacific Islander
Black or African American
White
Sepsis Mortality by Crude Rate per Age Group
600
500
Crude Rate
400
Philadelphia
300
Baltimore
San Francisco
200
100
0
85+
84-75
74 -65
64 -55
54-45
44 -35
Age Group (years)
34 -25
<1
Age Adjusted Rate of Sepsis Mortality by Gender
50
45
40
Age Adjusted Rate
35
30
Male
25
Female
20
15
10
5
0
Philadelphia
Baltimore
San Francisco
Preliminary Results
• Race
–
–
–
–
Healthcare
Socioeconomic status
Segregation
Comorbid diseases
• Age
– Misdiagnosis
– Quality of care
– Delayed treatment
• Sex
The Next Steps
• Further breakdown to determine exact
population
• Interviews with local specialists
Acknowledgements
• Dr. Matt Wray
• The Ronald E. McNair Post-Baccalaureate
Achievement Program
• My friends and family
References
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awareness and perception of sepsis*” Critical Care Medicine. 37
(1): 167-70.
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Sciences: Basic Discoveries for Better Health. April 2011.
Retrieved 22 April 2011
http://www.nigms.nih.gov/Publications/factsheet_sepsis.htm
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“Hospital Acquired Infections Surveillance and Control in
Intensive Care Services. Results of an Incidence
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2010.“Adverse event associated with a change in nonprescription
syringe sale policy” Journal of the American Pharmacists
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Monika M, and Howard, George . National variation in united states
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http://wonder.cdc.gov/cmf-icd10.html on May 25, 2011 8:54:47 PM
Questions?