Hotspotting sepsis: applying analytic tools from other disciplines to eliminate disparities

A recent manuscript by Moore and colleagues (1) identified geographic disparities in sepsis mortality. Using death certificates obtained from the National Center for Health Statistics, they performed a descriptive analysis of sepsis-related death over a 10-year period [2003–2012]. The investigators used three different approaches to identify mortality clusters (groups of sepsis death) in each of the 3,109 counties in the contiguous United States. They categorized sepsis deaths in each county as strongly clustered, moderately clustered, or nonclustered, based on clustering method agreement (agreement between three methods, two methods, and less than two methods, respectively). After adjusting for patient age and county-level characteristics (e.g., education, income, percentage of medically uninsured) the cluster groups had the following average mortality rates: 85.7 per 100,000 for strongly-clustered, 74.8 per 100,000 for moderately-clustered, and 56.8 per 100,000 for nonclustered counties. The investigators found that 92% of strongly- and moderately-clustered counties were located in the south. Sepsis-related mortality was highest in three regions, all within the Southeastern United States: “Mississippi Valley”, “Middle Georgia”, and “Central Appalachia”. Strongly clustered sepsis counties were more likely to have a higher percentage of residents who are unemployed, uninsured, and with less education and lower income