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Urban–Rural Disparities in Case Fatality of Community-Acquired Sepsis in Germany: A Retrospective Cohort Study

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  • Claudia T. Matthaeus-Kraemer

    (Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany
    Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany
    These authors contributed equally to this work.)

  • Norman Rose

    (Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany
    Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany
    These authors contributed equally to this work.)

  • Melissa Spoden

    (Wissenschaftliches Institut der Ortskrankenkassen, 10178 Berlin, Germany)

  • Mathias W. Pletz

    (Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany)

  • Konrad Reinhart

    (Department of Anesthesiology and Operative Intensive Care, Charité University Medicine Berlin, 10117 Berlin, Germany)

  • Carolin Fleischmann-Struzek

    (Institute of Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany
    Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany)

Abstract

Background: We aimed to examine urban–rural disparities in sepsis case fatality rates among patients with community-acquired sepsis in Germany. Methods: 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 (OR adj ) using logistic regression models to account for potential differences in the distribution of age, comorbidities, and sepsis characteristics between rural and urban citizens. Results: 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), OR adj = 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), OR adj = 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 (OR adj = 0.49 (95% CI 0.23, 0.75), p = 0.002). Conclusion: 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.

Suggested Citation

  • Claudia T. Matthaeus-Kraemer & Norman Rose & Melissa Spoden & Mathias W. Pletz & Konrad Reinhart & Carolin Fleischmann-Struzek, 2023. "Urban–Rural Disparities in Case Fatality of Community-Acquired Sepsis in Germany: A Retrospective Cohort Study," IJERPH, MDPI, vol. 20(10), pages 1-12, May.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:10:p:5867-:d:1150426
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    References listed on IDEAS

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    1. World Bank Group, 2021. "Demographic Trends and Urbanization," World Bank Publications - Reports 35469, The World Bank Group.
    2. Weinhold, Ines & Gurtner, Sebastian, 2014. "Understanding shortages of sufficient health care in rural areas," Health Policy, Elsevier, vol. 118(2), pages 201-214.
    3. Eberechukwu Onukwugha & Jason Bergtold & Rahul Jain, 2015. "A Primer on Marginal Effects—Part I: Theory and Formulae," PharmacoEconomics, Springer, vol. 33(1), pages 25-30, January.
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