Trends and disparities in sepsis-related mortality among patients with malignancies: A 25-year nationwide analysis.

Abstract

11062 Background: Sepsis is a leading cause of mortality worldwide, with cancer patients at higher risk due to immune suppression from the disease and its treatments. Despite advancements in sepsis care, their impact on sepsis-related mortality among cancer patients remains unclear. Understanding these trends is crucial for developing targeted interventions to improve sepsis outcomes in patients with malignancies. Methods: We conducted a retrospective cohort analysis using the CDC WONDER database from 1999 to 2023, focusing on adults aged >25 years with malignancies. Deaths were identified using international classification of disease 10 (ICD-10) codes for instances where both sepsis and malignant neoplasms were listed as causes of death. Age-adjusted mortality rates (AAMR) per 100,000 population were extracted, and temporal trends were analyzed using Joinpoint regression to calculate the annual percentage change (APC) and its weighted average, the average annual percentage change (AAPC). Results were stratified to evaluate temporal, gender-based, racial, and geographic disparities in mortality. Results: From 1999 to 2023, a total of 684,930 sepsis-related deaths were recorded among adults with malignancies. Over this period, the AAMR increased significantly from 12.06 to 14.21, with an AAPC of 0.86 (95% CI: 0.74 to 1.06). Males had a higher overall AAMR (15.09) compared to females (9.91), but females experienced a sharper increase over time (23.77% vs. 9.56%). Non-Hispanic (NH) Black or African Americans had the highest AAMR (18.98), followed by NH American Indian or Alaska Natives (11.59) and NH Whites (11.35), while NH Asians/Pacific Islanders exhibited the lowest rate (10.24). Geographic disparities were significant, with state-specific AAMRs ranging from 24.62 in the District of Columbia to 7.50 in Montana. States in the top 90 th percentile included Mississippi, Rhode Island, West Virginia, New Jersey, and the District of Columbia, while those in the bottom 10 th percentile included Montana, Oregon, Idaho, and Wisconsin. Regionally, the Northeast had the highest AAMR (12.65), followed by the South (12.49) and West (11.69), with the Midwest exhibiting the lowest rate (11.08). Conclusions: This nationwide analysis highlights a concerning rise in sepsis-related mortality among patients with malignancies over the past 25 years, with females, NH Blacks and residents of the Northeastern region emerging as the most vulnerable populations. These findings underscore the need for prompt implementation of targeted strategies designed to overcome these disparities.