P2.C048: National Trends and Racial Disparities in Sepsis-Related Mortality in Children in the United States, 1999 - 2019.

Background: Recent studies have demonstrated racial differences in sepsis-related mortality in adults but the data on children are conflicting. Additionally, little is known about the trends in sepsis-related mortality in the United States (US). We examined the national trends and racial disparities in sepsis-related mortality rate (SRMR) in children in the US from 1999 to 2019.

Methods: We conducted a retrospective serial cross-sectional analysis of national US death certificate data from the CDC’s Wide-ranging Online Database for Epidemiologic Research for the years 1999 through 2019. We used ICD-10 codes to identify children aged 0-18 years whose death certificates listed bacterial sepsis as the underlying cause of death. We excluded deaths from viral, fungal, protozoal/parasitic, tuberculous, and rickettsial illnesses. The crude SRMR was calculated per 100,000 population. We used the July 1 resident population for each year. The SRMR was stratified by age, gender, race, and census region. We categorized metropolitan areas as urban and others as rural. Race was ascertained based on death certificate reporting. The Mann-Whitney U test was used to compare two groups and P  < 0 .05 defined statistical significance. We examined temporal trends with Joinpoint regression, and this was expressed as average annual percentage change (AAPC) with 95% confidence intervals (CI). For sensitivity analysis, we repeated the analysis with bacterial sepsis as a cause of death regardless of the underlying cause of death.

Results: Among 1.6 billion children, 23,466 had bacterial sepsis as the underlying cause of death [1.4 per 100,000; CI, 1.4 -1.5)]. Of those with SRM, 81.5% were infants, 55.4% were males, 43.4% were NHW, 31.4% were NHB, and 85.5% were in urban areas. The SRMR differed by age, gender, race, and geographic region (Table 1). The overall SRMR decreased from 1.7 in 1999 to 1.2 in 2019 with an AAPC of -1.9% (CI: -2.4, -1.3%) [Figure 1]. Similarly, the SRMR decreased in males (1.9 to 1.2; AAPC -2.2%, CI: -2.5, -1.9), females (AAPC -2%, CI: -2.5, -1.6), NHB (AAPC -1.7%, CI: -2.3, -0.9); NHW (AAPC -2.1%, CI: -2.4, -1.6), rural areas (AAPC -2.5%, CI: -3.4, -1.5), urban areas (AAPC -1.9%, CI: -2.3, -1.5), and in all census regions. The overall NHB-to-NHW SRMR ratio was 2.7 and there was no significant change during the study period. We repeated the analysis with any mention of sepsis as the cause of death and the differences and trends in SRMR remained unchanged (Figure 1B).

Conclusion: The SRMR declined significantly overall and for all races, genders, and geographic regions. T disparity in SRMR between NHB and NHW suggesting the possibility of differential access to care, recognition, and prompt treatment of sepsis. Further studies are needed to unravel the underlying causes of this disparity in mortality outcomes.