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 ID: 399079
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Web of Causality: Sepsis Mortality in Philadelphia
Melissa Lester
Dr. Matt Wray
Department of Sociology
Temple University
Philadelphia, PASlide2
What is Sepsis?
Bacteria or fungus enter bloodstream
2
Community or hospital acquired3Response by innate immune system to infections4Release cytokinesBlood vessel dilation and ClotsOrgan ImpairmentOrgan Failure
TreatmentAntibiotics, oxygen, and fluids
5Slide3
An Open Inquiry
Exploring an obscure trend
Sepsis mortality
2nd highest rate of large citiesPhiladelphiaLeads to several questionsMedical factorsSocial factorsPlaceAim to solve puzzle of high mortality rateSlide4
Sepsis Mortality by the Numbers
Databases with mortality figures
WISQARS
WONDER10th leading cause of death in the U.S.Low sepsis awarenessInternational survey 22% have heard of the term1
10 Leading Causes of Death, United States
2000 - 2007, All Races, Both SexesSlide5
Background Literature
Sepsis
Undiagnosed HIV
6HIV2,8
Trauma2,4,12
Inaccessible Healthcare
7
Recreational Drug Use
4
Diabetes
2,7
Alcohol Abuse
7,9
Inactivity
10
ICU Admission
3
Malnutrition
10
Smoking
11
Lung Cancer
2,7Slide6
Background Literature
Risk factors influenced by
Municipal Laws
Social EnvironmentPhysical EnvironmentSepsisUndiagnosed HIV6
Recreational Drug Use4
Store Policy for Selling Syringes
13
Policies for HIV Testing
14
Social Disorder
15
Community Organizations for Prevention of Drug Use
16
Shooting Galleries
17Slide7
How to Measure Sepsis Mortality?
ICD-10
Septicaemia
codes18A40-A41ReliabilityWang et al19: wider definition for researchDeath by infectionA40 Streptococcal
septicaemia
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 Septicaemia due
to Streptococcus
pneumoniae Pneumococcal
septicaemia
A40.8 Other
streptococcal
septicaemia
A40.9 Streptococcal
septicaemia,
unspecified Slide8
Comparing Sepsis Mortality Rates
Rank large cities
Septicemia A40-A41
Codes of Wang et alCompare Philadelphia to large cities with low and high sepsis mortalityThree cities:Baltimore 1st Philadelphia 2ndSan Francisco 62ndSlide9
Deconstructing the Numbers
Complied data for three variables
Race
AgeSexCompared rates between the three citiesRace
Race Code
Deaths
Population
Crude Rate
Age Adjusted Rate
Asian or Pacific Islander
A-PI
65
637031
10.2
19.9
Black or African American
2054-5
2141
5360450
39.9
45.7
White
2106-3
2249
5746689
39.1
28.8
Sepsis Mortality in terms of Race in Philadelphia
20Slide10Slide11Slide12Slide13
Preliminary Results
Race
Healthcare
Socioeconomic statusSegregationComorbid diseasesAgeMisdiagnosisQuality of careDelayed treatmentSexSlide14
The Next Steps
Further
breakdown to determine exact population
Interviews with local specialistsSlide15
Acknowledgements
Dr. Matt Wray
The
Ronald E. McNair Post-Baccalaureate Achievement ProgramMy friends and familySlide16
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.htm3. 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
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Clinical Infectious Diseases.
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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.”
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Latkin, Carl A., et al. 2005. "Neighborhood Social Disorder as a Determinant of Drug Injection Behaviors: A Structural Equation Modeling Approach."
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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
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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 PMSlide17
Questions?