The epidemiology of sepsis in the United States from 1979 through 2000

Martin, Greg S.; Mannino, David M.; Eaton, Stephanie; Moss, Marc

doi:10.1056/nejmoa022139

Cited by 5,841Sepsis Diagnosis and TreatmentNeonatal and Maternal InfectionsBacterial Infections and Vaccines

The epidemiology of sepsis in the United States from 1979 through 2000

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Martin, Greg S., Mannino, David M., Eaton, Stephanie, Moss, Marc·2003·New England Journal of Medicine

DOI 10.1056/nejmoa022139

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Abstract

BACKGROUND: Sepsis represents a substantial health care burden, and there is limited epidemiologic information about the demography of sepsis or about the temporal changes in its incidence and outcome. We investigated the epidemiology of sepsis in the United States, with specific examination of race and sex, causative organisms, the disposition of patients, and the incidence and outcome. METHODS: We analyzed the occurrence of sepsis from 1979 through 2000 using a nationally representative sample of all nonfederal acute care hospitals in the United States. Data on new cases were obtained from hospital discharge records coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULTS: Review of discharge data on approximately 750 million hospitalizations in the United States over the 22-year period identified 10,319,418 cases of sepsis. Sepsis was more common among men than among women (mean annual relative risk, 1.28 [95 percent confidence interval, 1.24 to 1.32]) and among nonwhite persons than among white persons (mean annual relative risk, 1.90 [95 percent confidence interval, 1.81 to 2.00]). Between 1979 and 2000, there was an annualized increase in the incidence of sepsis of 8.7 percent, from about 164,000 cases (82.7 per 100,000 population) to nearly 660,000 cases (240.4 per 100,000 population). The rate of sepsis due to fungal organisms increased by 207 percent, with gram-positive bacteria becoming the predominant pathogens after 1987. The total in-hospital mortality rate fell from 27.8 percent during the period from 1979 through 1984 to 17.9 percent during the period from 1995 through 2000, yet the total number of deaths continued to increase. Mortality was highest among black men. Organ failure contributed cumulatively to mortality, with temporal improvements in survival among patients with fewer than three failing organs. The average length of the hospital stay decreased, and the rate of discharge to nonacute care medical facilities increased. CONCLUSIONS: The incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining. There are also disparities among races and between men and women in the incidence of sepsis. Gram-positive bacteria and fungal organisms are increasingly common causes of sepsis.

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The approach follows methods validated by many studies on the epidemiology of sepsis and was used by Rudd and colleagues.
“This approach follows the methods validated by many studies on the epidemiology of sepsis26, 27, 28, 29 and was used by Rudd and colleagues.10”
From Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 (2024) · cites this paper as [28]
Candida bloodstream infection increased by more than 200% from 1979 to 2000.
“This trend continued with a greater than 200% increase from 1979 to 2000.23”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [23]
Multiple-cause mortality due to mycoses in the United States increased from 1,557 deaths in 1980 to 6,534 deaths in 1997.
“McNeil et al. (154) published an analysis of trends in infectious disease mortality in the United States and found a dramatic increase in multiple-cause mortality due to mycoses, from 1,557 deaths in 1980 to 6,534 deaths in 1997; the majority of these mycoses-related deaths were associated with Candida , Aspergillus , and Cryptococcus sp. infection.”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [154]
McNeil et al. showed an almost exponential increase in mortality rates associated with invasive aspergillosis, with a 357% increase between 1980 and 1996.
“At the same time, they showed an almost exponential increase in the mortality rates associated with IA, with a 357% increase in mortality between 1980 and 1996.”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [154]
McNeil et al. demonstrated that mortality rates associated with invasive candidiasis increased steadily from 1980 to a peak in 1989, followed by a gradual decline through 1996.
“Previously, McNeil et al. (154) demonstrated that mortality rates associated with IC increased steadily from 1980 to a peak in 1989, followed by a gradual decline through 1996.”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [154]

The mortality data for invasive candidiasis and invasive aspergillosis for 1991 through 2003 are directly comparable to those of McNeil et al. and extend the data reported in that study beyond 1996 to 2003.
“These data are directly comparable to those of McNeil et al. (154) and extend the data reported in that study beyond 1996 to the year 2003.”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [154]
Limitations of multiple-cause-of-death data include lack of validation of the mycotic infection and failure to clinically diagnose invasive aspergillosis and invasive candidiasis, resulting in an underestimation of mortality.
“Again, the limitations of such data are well known, most notably the lack of validation of the mycotic infection and the failure to clinically diagnose IA and IC, resulting in an underestimation of mortality (154).”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [154]
Mortality associated with invasive mycoses is best represented by multiple-cause-of-death data, which capture any mention of the mycotic disease on the death certificate.
“As stated by McNeil and colleagues (154), mortality associated with invasive mycoses is best represented by multiplecause-of-death data, which capture any mention of the mycotic disease on the death certificate.”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [154]
The NHDS approach is likely to underestimate both incidence and mortality of invasive candidiasis because of miscoding, use of codes not captured by the analysis, or failure to code the infection at all.
“Although this approach provides a much more generalizable sample of U.S. hospitals than many other methods of surveillance, it is likely to underestimate both incidence and mortality because of miscoding of IC, use of codes not captured by the analysis, or failure to code the infection at all (79, 154).”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [154]

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Authors: Martin, G. S., Mannino, D. M., Eaton, S., & Moss, M.
Affiliations: Emory University (US)
Centers for Disease Control and Prevention (US)
ORCID: Martin, Greg S.
Mannino, David M.
Moss, Marc
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2003-04-17
Volume: 348
Issue: 16
Pages: 1546-1554
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa022139
OpenAlex: W2145577370
Cited by: 5,841
References: 48
Citations by year: 2026: 67 · 2025: 128 · 2024: 149 · 2023: 168 · 2022: 167 · 2021: 253 · 2020: 231 · 2019: 211 · 2018: 226 · 2017: 329 · 2016: 292 · 2015: 341 · 2014: 381 · 2013: 436 · 2012: 365
FWCI: 123.48
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
UKnowledge (University of Kentucky) (submittedVersion)
Funders: National Institute on Alcohol Abuse and Alcoholism (AA R01-11660, R01AA011660)
National Heart, Lung, and Blood Institute (K23HL067739, HL K23-67739)
National Center for Research Resources (L30 RR020488)
Topics: Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords: PSIS, sepsis incidence, sepsis mortality, temporal trends, racial disparities, sex differences, Gram-positive bacteria, fungal infection, sepsis pathogens, organ failure, length of hospital stay, hospital discharge disposition, Black men, hospital discharge data, acute care hospitals, healthcare burden
MeSH terms: Female, Humans, Male, Middle Aged, Multiple Organ Failure, Sex Factors, United States, Incidence, Survival Rate, Hospital Mortality, Sepsis, Racial Groups

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The epidemiology of sepsis in the United States from 1979 through 2000

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