背景:我们旨在研究德国社区获得性脓毒症患者中脓毒症病死率的城乡差异。
方法:使用全国法定健康保险AOK的去识别数据进行回顾性队列研究,覆盖约。占德国人口的30%。我们比较了农村和城市脓毒症患者的住院和12个月病死率。我们使用逻辑回归模型计算了具有95%置信区间的比值比(OR)和估计的调整比值比(ORadj),以解释年龄分布的潜在差异,合并症,城乡居民败血症特征。
结果:我们在2013-2014年确定了118,893例社区获得性脓毒症住院患者,直接入院。与城市地区相比,来自农村地区的脓毒症患者的住院病死率较低(23.7%vs.25.5%,p<0.001,赔率比(OR)=0.91(95%CI0.88,0.94),ORadj=0.89(95%CI0.86,0.92))。在12个月的病死率中可以观察到类似的差异(农村的45.8%与47.0%城市12个月病死率,p<0.001,OR=0.95(95%CI0.93,0.98),ORadj=0.92(95%CI0.89,0.94))。在患有严重社区获得性败血症的农村患者或因紧急情况而入院的患者中,也可以观察到生存益处。与该年龄段的城市患者相比,<40岁的农村患者在医院死亡的几率为一半(ORadj=0.49(95%CI0.23,0.75),p=0.002)。
结论:农村居民与社区获得性脓毒症患者的短期和长期生存获益相关。对患者的进一步研究,社区,和卫生保健系统因素需要了解这些差异的成因机制。
We aimed to examine
urban-rural disparities in sepsis
case fatality rates among patients with community-acquired sepsis in Germany.
Retrospective cohort study using de-identified data of the nationwide statutory health insurance AOK, covering approx. 30% of the German population. We compared in-hospital- and 12-month
case fatality between rural and
urban sepsis patients. We calculated odds ratios (OR) with 95% confidence intervals and the estimated adjusted odds ratio (ORadj) using logistic regression models to account for potential differences in the distribution of age, comorbidities, and sepsis characteristics between rural and urban citizens.
We identified 118,893 hospitalized patients with community-acquired sepsis in 2013-2014 with direct hospital admittance. Sepsis patients from rural areas had lower in-hospital
case fatality rates compared to their
urban counterparts (23.7% vs. 25.5%, p < 0.001, Odds Ratio (OR) = 0.91 (95% CI 0.88, 0.94), ORadj = 0.89 (95% CI 0.86, 0.92)). Similar differences were observable for 12-month
case fatalities (45.8% rural vs. 47.0%
urban 12-month
case fatality, p < 0.001, OR = 0.95 (95% CI 0.93, 0.98), ORadj = 0.92 (95% CI 0.89, 0.94)). Survival benefits were also observable in rural patients with severe community-acquired sepsis or patients admitted as emergencies. Rural patients of <40 years had half the odds of dying in hospital compared to urban patients in this age bracket (ORadj = 0.49 (95% CI 0.23, 0.75), p = 0.002).
Rural residence is associated with short- and long-term survival benefits in patients with community-acquired sepsis. Further research on patient, community, and health-care system factors is needed to understand the causative mechanisms of these disparities.