Disparities in patient mortality following intensive care admission due to adult community-acquired sepsis in Aotearoa New Zealand, 2009-2019.

Abstract

Aim: To characterise patient mortality risk following intensive care unit (ICU) admitted community-acquired sepsis (CAS) in Aotearoa New Zealand (Aotearoa), comparing in-hospital and post-discharge mortality and associated risk factors.

Methods: We examined de-identified, linked ICU-admitted adult patient data from ICU sites in Aotearoa retrieved from the Australian and New Zealand Intensive Care Society's CORE adult patient database (ANZICS-CORE-APD) between 2009 and 2019. Patients were followed from ICU admission to death or 365 days post-hospital discharge alive, using descriptive, survival and regression analyses. The outcomes of interest were in-hospital mortality and post-discharge mortality during the first 365 days.

Results: In-hospital mortality was 16.3%. Post-discharge mortality was 3.6% by 30 days after discharge, 9.1% by 180 days and 12.9% by 365 days. There was no significant difference in in-hospital mortality risk by ethnicity or New Zealand Index of Deprivation quintile of usual residence. By contrast, significant differences in post-discharge survival were observed by ethnicity, area deprivation quintile and presence of severe comorbidities, particularly for Māori usually resident in high-deprivation areas.

Conclusions: There was no evidence of associations between in-hospital mortality and ethnicity or socio-economic deprivation; however, these associations become marked post-discharge. Interventions should be implemented to support early identification and management of CAS and address health inequities following hospital discharge.