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.

Using routine data to measure ethnic differentials in access to coronary revascularization.

BACKGROUND: Ethnic inequalities in access to health services are difficult to monitor and address because of limited data. Within the health service, ethnicity data have been poor quality, partly because they are not seen as useful. METHODS: The analysis related age- and sex-standardized coronary revascularization procedures to defined measures of need, using proportional ratios derived from Hospital Episode Statistics records for London residents admitted to any hospital nationally in 2002-03 or 2003-04. RESULTS: Although 2001 Ethnicity Categories were mandatory for the NHS from April 2001, by 2003-04 >20% of coronary heart disease (CHD) records still had no ethnic category coded. Hospital admission for CHD and revascularization by ethnicity varied widely, following known patterns of CHD incidence and mortality. There is much less variation between ethnic groups when comparing revascularization rate relative with CHD admission rates (whether all or emergencies). However, Bangladeshi patients had only two-thirds [proportional ratio 66.8, 95% confidence interval (CI) 60.7-73.3] and Black Caribbean and Black African patients four-fifths (proportional ratios 80.5, 72.0-89.9 and 80.7, 68.0-95.2, respectively) the revascularization rate in comparison with apparent need as the general population. CONCLUSION: Even with imperfect data, the analysis of routine data can identify inequalities that warrant further investigation.