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Web of Causality: Sepsis Mortality in Philadelphia

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 bloodstream 2 Community or hospital acquired 3 Response by innate immune system to infections 4

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Web of Causality: Sepsis Mortality in Philadelphia

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  1. Web of Causality: Sepsis Mortality in Philadelphia Melissa Lester Dr. Matt Wray Department of Sociology Temple University Philadelphia, PA

  2. 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

  3. 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

  4. 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 States2000 - 2007, All Races, Both Sexes

  5. Background Literature HIV2,8 Trauma2,4,12 Undiagnosed HIV6 Lung Cancer2,7 Inaccessible Healthcare7 Smoking11 Sepsis Recreational Drug Use4 Malnutrition10 Alcohol Abuse7,9 ICU Admission3 Diabetes2,7 Inactivity10

  6. Background Literature Store Policy for Selling Syringes13 • Risk factors influenced by • Municipal Laws • Social Environment • Physical Environment Recreational Drug Use4 Sepsis Policies for HIV Testing14 Social Disorder15 Undiagnosed HIV6 Community Organizations for Prevention of Drug Use16 Shooting Galleries17

  7. How to Measure Sepsis Mortality? • ICD-10 • Septicaemia codes18 • A40-A41 • Reliability • Wang et al19: wider definition for research • Death by infection A40 Streptococcalsepticaemia 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 SepticaemiaduetoStreptococcuspneumoniae Pneumococcalsepticaemia A40.8 Otherstreptococcalsepticaemia A40.9 Streptococcalsepticaemia, unspecified

  8. 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

  9. Deconstructing the Numbers • Complied data for three variables • Race • Age • Sex • Compared rates between the three cities Sepsis Mortality in terms of Race in Philadelphia20

  10. Preliminary Results • Race • Healthcare • Socioeconomic status • Segregation • Comorbid diseases • Age • Misdiagnosis • Quality of care • Delayed treatment • Sex

  11. The Next Steps • Further breakdown to determine exact population • Interviews with local specialists

  12. Acknowledgements • Dr. Matt Wray • The Ronald E. McNair Post-Baccalaureate Achievement Program • My friends and family

  13. References 1. Rubulotta, Francesca M. 2009. “ An International survey: Public awareness and perception of sepsis*” Critical Care Medicine. 37 (1): 167-70. 2. “Sepsis fact sheet” NIH. National Institute of General Medical Sciences: Basic Discoveries for Better Health. April 2011. Retrieved 22 April 2011 http://www.nigms.nih.gov/Publications/factsheet_sepsis.htm 3. M. Costantini, P. M. Donisi, M. G. Turrin and L. Diana. 1987. “Hospital Acquired Infections Surveillance and Control in Intensive Care Services. Results of an Incidence Study”.European Journal of Epidemiology. 3(4): 347-355.4. Young, Lowell S. MD. 2008. “Sepsis and Septic Shock” Merk Sharp & Dohme Corp. Retrieved 22 Apr 2011. http://www.merckmanuals.com/home/sec17/ch191/ch191c.html 5. “Cytokines.”Nordic BioSite. Retrieved 16 June 2011. http://www.nordicbiosite.dk/ViewGlossary.aspx?id=93 6. Vinnard C. “Racial differences in rates of severe sepsis”. 2010. JAMA: The Journal of the American Medical Association. 304:1556-1556 7. Moss, Marc. 2005. “Epidemiology of Sepsis: Race, Sex, and Chronic Alcohol Abuse.”Clinical Infectious Diseases. 41, (Supplement 7. Identifying Responsive Populations in Sepsis): S490-S497. 8. Lever, Andrew and Mackenzie, Iain. 2007. “Sepsis: Definition, Epidemiology, and Diagnosis.” BMJ: British Medical Journal. 335( 7625): 879-883. 9. Seymour, MD Christopher W.; Iwshyna, MD, PhD, Theodore J.; Cooke, MD, MSc, colin R; Hough MD, MSc, Catherine L.; Martin MD, MSc, FCCP, Grey S. 2010. “Marital Status and the Epidemiology and Outcomes of Sepsis.” . American College of Chest Physicians. CHEST 137 ( 6): 1289-1296. 10. Ouellet, Lawrence J., et al. 1991. "Shooting Galleries and HIV Disease: Variations in Places for Injecting Illicit Drugs." Crime & Delinquency 37 (1):64-85. 11. Chaloupka, Frank. 1992. "Clean Indoor Air Laws, Addiction and Cigarette Smoking." Applied Economics 24 (2):193. 12. Thornhill, Robert, et al. 2010. "Trauma Sepsis." Trauma 12 (1):31-49. 13. Zaller ND, Yokell MA, Jeronimo A, Bratberg JP, Case P, Rich JD. 2010.“Adverse event associated with a change in nonprescription syringe sale policy” Journal of the American Pharmacists Association. American Pharmacists Association. 50(5) :619-622. 14. Vakduserrum, Ranold.; Holtgrave, David R.; West, Gary R. 1999. “Promoting early HIV diagnosis and entry into care.” AIDS (London) 13(17): 2317-2330. 15. Latkin, Carl A., et al. 2005. "Neighborhood Social Disorder as a Determinant of Drug Injection Behaviors: A Structural Equation Modeling Approach." Health Psychology 24 (1):96-100. 16. Aguirre-Molina, M. 1996. “Community-Based Approached For the Prevention of Alcohol, Tobacco, and other drug use” Annual Review of Public Health. 17(1): 337-58. 17. Ouellet, Lawrence J., et al. 1991. "Shooting Galleries and HIV Disease: Variations in Places for Injecting Illicit Drugs." Crime & Delinquency 37 (1):64-85. 18. “ International Statistical Classification of Diseases and Related Health Problems 10th Revision: Version for 2007”. WHO. Retrieved24 May 2011. http://apps.who.int/classifications/apps/icd/icd10online/. 19. Wang, Henry E.; Devereaux, Randolph S; Yealy, Donald M; Safford, Monika M, and Howard, George . National variation in united states sepsis mortality: A descriptive study. International Journal of Health Geographics, 9(1), 9. 20. Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2007. CDC WONDER On-line Database, compiled from Compressed Mortality File 1999-2007 Series 20 No. 2M, 2010. Accessed at http://wonder.cdc.gov/cmf-icd10.html on May 25, 2011 8:54:47 PM

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