U.S. Sees Decline in Sepsis Deaths, But Some Americans More Vulnerable
While deaths from sepsis have dropped in the United States since 2000, older Americans remain particularly susceptible to the life-threatening bacterial infection, new government data shows.
Sepsis strikes roughly 2 million people each year and is the cause of one in three hospital deaths in the United States, according to the U.S. Centers for Disease Control and Prevention.
"Sepsis is typically a complication of another condition or infection, and can occur at any age, but older adults are at high risk for serious complications and death," said report author Ellen Kramarow, from the division of analysis and epidemiology at the CDC's National Center for Health Statistics (NCHS), in Hyattsville, Md.
Nearly 87% of sepsis infections start outside the hospital, much like what happened to 75-year-old former President Bill Clinton. He was hospitalized in October after suffering a urinary tract infection that triggered sepsis. Clinton remained in the hospital until he had completed a course of powerful antibiotics, which can only be given intravenously.
Sepsis typically occurs when the body has an extreme response to an infection. Infections that can trigger sepsis most often start in the lung, urinary tract, skin or gastrointestinal tract. Without timely treatment, sepsis can quickly lead to tissue damage, organ failure and death.
In the new U.S. study, Kramarow used data from the National Vital Statistics System to look at the toll sepsis takes on those aged 65 and older. Deaths from sepsis declined between 2000 and 2019, yet three-fourths of those deaths were among people 65 and older.
According to the report, deaths from sepsis increased with age. The rates were about five times higher for those 85 and older (750 per 100,000) than for those aged 65 to 74 (151 per 100,000).
Also, deaths from sepsis were higher among Black patients (377 per 100,000) than among white patients (276 per 100,000), Asian patients (180 per 100,000) or Hispanic patients (246 per 100,000), the findings showed.
Deaths from sepsis were also higher among men than women, and in rural areas than in cities, Kramarow discovered.
The findings were published online Nov. 10 in a CDC NCHS Data Brief.
The decline in sepsis deaths is the result of better treatment and access to care, said infectious disease expert Dr. Marc Siegel, a clinical professor of medicine at NYU Langone Medical Center in New York City.
"If you don't treat sepsis right away — that's when we lose people," he said. "Early identification and early intervention and then advanced biotechnological monitoring — that's the key."
Siegel thinks, however, that the pandemic may have caused an uptick in sepsis deaths as resources were diverted elsewhere to combat COVID-19. "I'm expecting that there was an impact on sepsis in terms of the pandemic," he said.
Older people are more susceptible to sepsis for several reasons, Siegel noted. For one, older people don't fight off infections as well as younger people. So urinary tract infections, which younger people can easily handle, can spread throughout the body in older people, he said.
"By the time it's diagnosed, it's later on," Siegel said. "That may be what we just saw with former President Clinton."
And, he added, "Older people not only don't have the immune defenses of younger people, but they also have co-morbidities that can make it more likely where one organ system or another is worn down, like the lungs, like the kidneys. They are more likely to get those kinds of infections to begin with. The older you are, the more at risk you are for a serious life-threatening infection that you have to jump on right away."
For Black patients and those living in rural areas, the higher death rates from sepsis may be due to a combination of lack of access to care and later diagnosis, which both affect the outcome of a sepsis infection, Siegel said.
For more on sepsis, head to the U.S. Centers for Disease Control and Prevention.
SOURCES: Ellen Kramarow, PhD, division of analysis and epidemiology, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention; Marc Siegel, MD, clinical professor, medicine, NYU Langone Medical Center, New York City; NCHS Data Brief, Nov. 10, 2021, online