National trends in sepsis-related mortality among decedents with malignant neoplasms in the United States, 1999–2023.

Abstract

e13506 Background: Sepsis is one of the leading causes of death in cancer patients as a result of both immunosuppression, treatment-related toxicity, and comorbid conditions. With amelioration in cancer survival, sepsis has become a relatively more prominent competing cause of death. However, long-term national trends and the demographic differences in sepsis-associated death among decedents with malignant neoplasms have not been fully described. Methods: Death certificate data from the CDC WONDER database for adults aged ≥65 years from 1999 to 2023 were analyzed. Sepsis-related deaths were identified using ICD-10 codes for sepsis (A40 [streptococcal sepsis] and A41 [other sepsis]) listed as underlying or contributing causes of death among decedents with malignant neoplasms (ICD-10 codes C00–C97). Age-adjusted and age-specific mortality rates per 100,000 persons were calculated. Temporal trends were assessed using annual percent change (APC) and average annual percent change (AAPC) via Joinpoint regression. Results: From 1999 to 2023, sepsis-related mortality among individuals with malignant neoplasms in the United States increased, with the age-adjusted mortality rate (AAMR) rising from 1.27 in 1999 to 1.68 in 2023. Overall mortality increased significantly (AAPC 1.15%; 95% CI 0.61–1.69; p < 0.001). Mortality rates were higher in men than women (AAMR 1.67 vs 1.06). Among women, mortality increased overall (AAPC 1.59%; p < 0.001), with a pronounced rise from 2019–2023. Non-Hispanic Black individuals had the highest AAMR (2.12), followed by Non-Hispanic White (1.24) and Hispanic or Latino (0.89). All racial and ethnic groups exhibited post-2019 increases, with the steepest rise among Non-Hispanic Black individuals (APC 9.98%; p < 0.001). AAMRs were similar in metropolitan (1.26) and non-metropolitan areas (1.27); non-metropolitan areas showed a sustained increase (AAPC 1.05%; p = 0.004). Regionally, the Northeast had the highest AAMR (1.73), followed by the South (1.38), Midwest (1.27), and West (0.79), with post-2019 increases observed across all regions. The inflection in sepsis-related mortality after 2019 may reflect the combined effects of the COVID-19 pandemic, including health system strain, delayed cancer care, and potential changes in death certification practices. Conclusions: Targeted interventions are needed to reduce sepsis-related mortality among patients with malignant neoplasms in the United States, particularly in populations defined by sex, race and ethnicity, metropolitan status, and geographic region. Efforts should prioritize early recognition and prevention of sepsis, equitable access to timely oncologic and acute care, and focused strategies for high-risk groups.