Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010

OBJECTIVES To quantify mortality associated with sepsis in the whole population of England. DESIGN Descriptive statistics of multiple cause of death data. SETTING England between 2001 and 2010. PARTICIPANTS All people whose death was registered in England between 2001 and 2010 and whose certificate contained a sepsis-associated International Classification of Diseases, 10th Revision (ICD-10) code. DATA SOURCES Multiple cause of death data extracted from Office for National Statistics mortality database. STATISTICAL METHODS Age-specific and sex-specific death rates and direct age-standardised death rates. RESULTS In 2010, 5.1% of deaths in England were definitely associated with sepsis. Adding those that may be associated with sepsis increases this figure to 7.7% of all deaths. Only 8.6% of deaths definitely associated with sepsis in 2010 had a sepsis-related condition as the underlying cause of death. 99% of deaths definitely associated with sepsis have one of the three ICD-10 codes-A40, A41 and P36-in at least one position on the death certificate. 7% of deaths definitely associated with sepsis in 2001-2010 did not occur in hospital. CONCLUSIONS Sepsis is a major public health problem in England. In attempting to tackle the problem of sepsis, it is not sufficient to rely on hospital-based statistics, or methods of intervention, alone. A robust estimate of the burden of sepsis-associated mortality in England can be made by identifying deaths with one of the three ICD-10 codes in multiple cause of death data. These three codes could be used for future monitoring of the burden of sepsis-associated mortality.