Marital status and the epidemiology and outcomes of sepsis

Abstract

Background: Sepsis is a major public health problem. Social factors may affect health behaviors, economic resources, and immune response, leading to hospitalization for infection. This study examines the association between marital status and sepsis incidence and outcomes in a population-based cohort.

Methods: We analyzed 1,113,581 hospitalizations in New Jersey in 2006. We estimated risk-adjusted incidence rate ratios (IRRs) for sepsis among divorced, widowed, legally separated, single, and married subjects using population data from the American Community Survey. We used multivariable logistic regression to estimate marital status-specific hospital mortality.

Results: We identified 37,524 hospitalizations for sepsis, of which 40% were among married (14,924), 7% were among divorced (2,548), 26% were among widowed (9,934), 2% (763) were among legally separated, and 26% (9355) were among single subjects. The incidence of hospitalization for sepsis was 5.8 per 1,000 population. The age, sex, and race-adjusted IRR for hospitalization with sepsis was greatest for single (IRR = 3.47; 95% CI, 3.1, 3.9), widowed (IRR = 1.38; 95% CI, 1.2, 1.6), and legally separated (IRR = 1.46; 95% CI, 1.2, 1.8) subjects compared with married (referent). We observed that single men and women and divorced men had greater odds of in-hospital mortality compared with married men; widowed and legally separated men and all ever-married women had no excess mortality during hospitalization for sepsis.

Conclusions: Hospitalization for sepsis is more common among single, widowed, and legally separated individuals, independent of other demographic factors. Among patients hospitalized for sepsis, single and divorced men and single women experience greater hospital mortality, highlighting the need to characterize the potentially modifiable mechanisms linking marital status to its greater burden of critical illness.

Figure 1.

Diagram of cohort construction. SID = State Inpatient Database.

Figure 2.

Crude incidence rate of hospitalization for sepsis among married, widowed, legally separated, divorced, and single subjects across 5-year age groups. Single subjects are shown as black line, legally separated as dotted dark gray line, widowed subjects are depicted as dotted light gray line, divorced subjects as hashed light gray line, and married subjects as solid gray line. Incidence rate is reported per 1,000 population.

Figure 3.

Incidence rate ratios (IRRs) of hospitalization for sepsis in New Jersey, 2006. Estimates for rate ratios are adjusted for age, race, sex, and marital status. Single, widowed and divorced subjects, black non-Hispanics, Hispanics, and those with advanced age are at greater risk for hospitalization for sepsis. Point estimates for IRRs are displayed above symbols (online supplement), and line constitutes the 95% CI.