Risk Factors for Sepsis in the Community

社区败血症的危险因素

• 批准号: 8458902
• 负责人: Henry E. Wang
• 金额: $ 49.57万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-15 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8458902
• 关键词: Acute myocardial infarction; Adult; Alcohol consumption; Ancillary Study; Antibiotic Resistance; Breast; Cardiovascular Diseases; Caring; Case Fatality Rates; Cellulitis; Cessation of life; Characteristics; Cohort Studies; Communities; Community Healthcare; Comorbidity; Diabetes Mellitus; Elements; Event; Family; Family Characteristics; Funding; Health; Health Professional; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Individual; Infection; Inflammation; Influenza; Kidney Failure; Life; Malignant neoplasm of lung; Mediating; Medical; Medically Underserved Area; Medicare; Meningitis; National Institute of Neurological Disorders and Stroke; Obesity; Organ; Performance; Pneumonia; Predisposition; Prevention; Process; Public Health; Quality Indicator; Quality of Care; Reasons for Geographic And Racial Differences in Stroke; Research Infrastructure; Resources; Rest; Risk; Risk Factors; Risk Reduction; Rural; Science; Sepsis; Shock; Societies; Stroke; Syndrome; Testing; Tobacco use; United States Agency for Healthcare Research and Quality; United States Health Resources and Services Administration; Vaccination; Variant; Vital Statistics; base; body system; cohort; design; geographic difference; injured; innovation; kidney infection; malignant breast neoplasm; microbial; mortality; population based; prevent; racial difference

DESCRIPTION (provided by applicant): Sepsis, a condition of enormous public health importance, has two-fold regional variation in mortality in the US, with the highest cluster in the Southeastern US. Few studies have had the large-scale, national, population-based design required to explain these regional variations. Our proposed study will capitalize on the infrastructure of the 30,000 subject REGARDS community-based cohort, which has the elements needed to identify individual and community-level sepsis risk factors and their mediating effects on regional sepsis variations. Our study will advance sepsis science by identifying individual and community-level factors amenable to risk reduction, potentially leading to strategies to prevent sepsis and reduce its high mortality. Our study objectives are 1) identify individual, family, community and societal/system healthcare factors associated with sepsis attack rates and case fatality, and 2) determine their mediating effects on regional sepsis variations. Sepsis is a dangerous syndrome of body-wide systemic inflammation triggered by microbial infection. Sepsis may injure vital organs, resulting in shock and death. Sepsis is a major community threat, resulting in over 750,000 hospitalizations and 215,000 deaths in the US annually - exceeding deaths resulting from acute myocardial infarction, lung cancer or breast cancer. Our recent study indicates a Southeastern US "belt" of two-fold excess sepsis mortality, reflecting almost 8,500 excess sepsis deaths annually. To understand the reasons for regional variations in sepsis mortality, a study must be able to identify the pre-hospital individual and community-level risk factors associated with sepsis attack rates and case fatality. However, few studies have had the large-scale, national, population-based design required to examine these relationships. We propose an ancillary study to the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study, an ongoing NINDS-funded national cohort of >30,000 community-dwelling adults. Using the well- established infrastructure of this large cohort study, we will identify sepsis hospitalizations and deaths, drawing upon over 3,300 events across a 10-year span. We will test associations between baseline individual and community healthcare-related characteristics (resources, access and quality of care) and the risks of incident sepsis and 28-day sepsis death (case fatality), determining their mediating influences on regional sepsis variations. The specific aims of this study are to 1) Determine US geographic variations in sepsis susceptibility (attack rate) and case fatality, 2) Determine the individual and family characteristics that mediate sepsis geographic variations and 3) Determine the community and societal/system healthcare characteristics that mediate sepsis geographic variations.

描述（由申请人提供）：脓毒症是一种对公共卫生具有巨大重要性的疾病，在美国死亡率有两倍的区域差异，其中最高的集中在美国东南部。很少有研究能够进行大规模、全国性、基于人口的设计来解释这些区域差异。我们提出的研究将利用 30,000 名受试者 REGARDS 社区队列的基础设施，该队列具有识别个人和社区层面脓毒症风险因素及其对区域脓毒症变异的中介作用所需的要素。我们的研究将通过确定有助于降低风险的个人和社区层面的因素来推进脓毒症科学，从而有可能制定预防脓毒症并降低其高死亡率的策略。我们的研究目标是 1) 确定与败血症发病率和病死率相关的个人、家庭、社区和社会/系统医疗保健因素，2) 确定它们对区域败血症变异的中介作用。脓毒症是一种由微生物感染引发的全身系统性炎症的危险综合征。败血症可能会损伤重要器官，导致休克和死亡。败血症是一个重大的社区威胁，在美国每年导致超过 750,000 人住院治疗和 215,000 人死亡，超过了急性心肌梗塞、肺癌或乳腺癌导致的死亡人数。我们最近的研究表明，美国东南部的脓毒症死亡率“带”高出两倍，每年有近 8,500 例脓毒症死亡。为了了解脓毒症死亡率区域差异的原因，研究必须能够确定与脓毒症发作率和病死率相关的院前个人和社区层面的危险因素。然而，很少有研究具备检验这些关系所需的大规模、全国性、基于人群的设计。我们提议对卒中地理和种族差异的原因 (REGARDS) 研究进行一项辅助研究，该研究是一项由 NINDS 资助的正在进行的全国性队列研究，涉及超过 30,000 名社区居住的成年人。利用这项大型队列研究的完善基础设施，我们将根据 10 年期间的 3,300 多起事件来确定败血症住院和死亡情况。我们将测试基线个人和社区医疗保健相关特征（资源、获取和护理质量）与败血症事件和 28 天败血症死亡（病死率）的风险之间的关联，确定它们对区域败血症变异的中介影响。本研究的具体目的是 1) 确定美国脓毒症易感性（发病率）和病死率的地理差异，2) 确定介导脓毒症地理差异的个人和家庭特征，3) 确定社区和社会/系统医疗保健特征介导脓毒症的地理差异。