Association of Neighborhood Socioeconomic Status With Risk of Infection and Sepsis

Donnelly, John P.; Lakkur, Sindhu; Judd, Suzanne E.; Levitan, Emily B.; Griffin, Russell; Howard, George; Safford, Monika M.; Wang, Henry E.

doi:10.1093/cid/cix1109

Cited by 31 publications

(28 citation statements)

References 28 publications

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“…Using the disjunctive cause criterion (VanderWeele and Shpitser 2011 ) for confounder identification, we included age (in years), sex, socioeconomic status (SES) (Donnelly et al 2018 ), history of stroke (Chamorro et al 2007 ), any kind of cancer (Rolston 2017 ), myocardial infarction (Truffa et al 2012 ), diabetes mellitus type 1 or 2 (Casqueiro et al 2012 ), smoking status (Bagaitkar et al 2008 ), BMI (kg/m 2 ; with BMI > 30 defined as obese according to WHO definition (Dobner and Kaser 2018 ; WHO 2019 )), and hypertension as potential confounders (Gu et al 2017 ). All potential confounders were assessed as self-reported variables at baseline only, using a standardized interview.…”

Section: Methodsmentioning

confidence: 99%

Seropositivity for pathogens associated with chronic infections is a risk factor for all-cause mortality in the elderly: findings from the Memory and Morbidity in Augsburg Elderly (MEMO) Study

et al. 2020

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Immunostimulation by chronic infection has been linked to an increased risk for different non-communicable diseases, which in turn are leading causes of death in high- and middle-income countries. Thus, we investigated if a positive serostatus for pathogens responsible for common chronic infections is individually or synergistically related to reduced overall survival in community dwelling elderly. We used data of 365 individuals from the German MEMO (Memory and Morbidity in Augsburg Elderly) cohort study with a median age of 73 years at baseline and a median follow-up of 14 years. We examined the effect of a positive serostatus at baseline for selected pathogens associated with chronic infections (Helicobacter pylori, Borrelia burgdorferi sensu lato, Toxoplasma gondii, cytomegalovirus, Epstein-Barr virus, herpes simplex virus 1/2, and human herpesvirus 6) on all-cause mortality with multivariable parametric survival models. We found a reduced survival time in individuals with a positive serostatus for Helicobacter pylori (accelerated failure time (AFT) − 15.92, 95% CI − 29.96; − 1.88), cytomegalovirus (AFT − 22.81, 95% CI − 36.41; − 9.22) and Borrelia burgdorferi sensu lato (AFT − 25.25, 95% CI − 43.40; − 7.10), after adjusting for potential confounders. The number of infectious agents an individual was seropositive for had a linear effect on all-cause mortality (AFT per additional infection − 12.42 95% CI − 18.55; − 6.30). Our results suggest an effect of seropositivity for Helicobacter pylori, cytomegalovirus, and Borrelia burgdorferi sensu lato on all-cause mortality in older community dwelling individuals. Further research with larger cohorts and additional biomarkers is required, to assess mediators and molecular pathways of this effect.

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Section: Methodsmentioning

confidence: 99%

Seropositivity for pathogens associated with chronic infections is a risk factor for all-cause mortality in the elderly: findings from the Memory and Morbidity in Augsburg Elderly (MEMO) Study

et al. 2020

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“…Socioeconomic status, including access to care, has a substantial impact on sepsis incidence and outcomes. [28][29][30][31][32] In the present study, we assessed the socioeconomic status using urbanization levels, which may reflect access to care, and payrollrelated insurance premium. We found that both urbanization levels and payroll-related insured amount were associated with sepsis risk in a doseresponse manner.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with sepsis risk in immune-mediated inflammatory diseases receiving tumor necrosis factor inhibitors: a nationwide study

Chao

Wang

Hsu

et al. 2020

Therapeutic Advances in Musculoskeletal

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Background: Risk factors for sepsis have not been assessed in patients receiving tumor necrosis factor-alpha inhibitors (TNFi) for immune-mediated inflammatory diseases (IMIDs) who are vulnerable to serious/hospitalized infections. Methods: Data from 2003–2017 were obtained from Taiwan’s National Health Insurance Research Database to identify patients receiving TNFi, including etanercept, adalimumab, and golimumab, for IMIDs including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis (PsO), psoriatic arthritis (PsA), Crohn’s disease (CD), and ulcerative colitis (UC). To investigate risk factors for sepsis, we used the Sepsis-3 definition and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox regression analysis. Results: There were 17,764 patients (mean age 49.3 ± 14.3 years; females, 57.6%) receiving TNFi for IMIDs, including RA (58.6%), AS (19.1%), PsO (15.1%), PsA (2.5%), CD (3.0%), and UC (1.7%). The overall incidence rate of sepsis was 1088 per 100,000 person-years. After adjustment for potential confounders, recent sepsis within 3 months before TNFi initiation (HR, 2.35; 95% CI, 1.73–3.20), CD (HR, 3.36; 95% CI 2.11–5.34; reference group: AS) and glucocorticoid use (prednisolone-equivalent dose, mg/day HR, 1.05; 95% CI, 1.05–1.06) were associated with the risk of sepsis. Intriguingly, golimumab users appeared to have a lower risk of sepsis compared with etanercept users (HR, 0.56; 95% CI, 0.38–0.83). In addition, socioeconomic status, including urbanization level and insured amount, was associated with sepsis in a dose-response manner. Conclusions: Recent sepsis, CD, concomitant glucocorticoid use, and low socioeconomic status, which were associated with an increased risk of sepsis, are crucial for individualized risk management plans.

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“…Results from epidemiological studies are contrasting [45][46][47]. Ethnicity may also be associated with socioeconomic status, a health determinant recently found to be associated with a higher rate of hospital admissions for infection [48]. Future tracking of health-related social needs in structured EHR data [49] will support deeper investigation.…”

Section: Principal Findingsmentioning

confidence: 99%

Ambulatory Risk Models for the Long-Term Prevention of Sepsis: Retrospective Study

et al. 2021

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Background Sepsis is a life-threatening condition that can rapidly lead to organ damage and death. Existing risk scores predict outcomes for patients who have already become acutely ill. Objective We aimed to develop a model for identifying patients at risk of getting sepsis within 2 years in order to support the reduction of sepsis morbidity and mortality. Methods Machine learning was applied to 2,683,049 electronic health records (EHRs) with over 64 million encounters across five states to develop models for predicting a patient’s risk of getting sepsis within 2 years. Features were selected to be easily obtainable from a patient’s chart in real time during ambulatory encounters. Results The models showed consistent prediction scores, with the highest area under the receiver operating characteristic curve of 0.82 and a positive likelihood ratio of 2.9 achieved with gradient boosting on all features combined. Predictive features included age, sex, ethnicity, average ambulatory heart rate, standard deviation of BMI, and the number of prior medical conditions and procedures. The findings identified both known and potential new risk factors for long-term sepsis. Model variations also illustrated trade-offs between incrementally higher accuracy, implementability, and interpretability. Conclusions Accurate implementable models were developed to predict the 2-year risk of sepsis, using EHR data that is easy to obtain from ambulatory encounters. These results help advance the understanding of sepsis and provide a foundation for future trials of risk-informed preventive care.

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Association of Neighborhood Socioeconomic Status With Risk of Infection and Sepsis

Cited by 31 publications

References 28 publications

Seropositivity for pathogens associated with chronic infections is a risk factor for all-cause mortality in the elderly: findings from the Memory and Morbidity in Augsburg Elderly (MEMO) Study

Seropositivity for pathogens associated with chronic infections is a risk factor for all-cause mortality in the elderly: findings from the Memory and Morbidity in Augsburg Elderly (MEMO) Study

Factors associated with sepsis risk in immune-mediated inflammatory diseases receiving tumor necrosis factor inhibitors: a nationwide study

Ambulatory Risk Models for the Long-Term Prevention of Sepsis: Retrospective Study

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