Sepsis in the tropical top end of Australia's Northern territory

Disease burden and impact on indigenous Australians

Joshua S. Davis, Allen C. Cheng, Mark McMillan, Alex B. Humphrey, Dianne P. Stephens, Nicholas M. Anstey

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: To describe the clinical and epidemiological features of sepsis and severe sepsis in the population of the tropical Top End of the Northern Territory of Australia and compare these with published estimates for temperate Australia, the United States and Europe.

    Design, setting and participants: 
    Prospective cohort study in the major hospital for tropical NT, a region where 27% of the population are Indigenous. We screened all adult (≥ 15 years) acute hospital admissions over a 12-month period (6 May 2007 – 5 May 2008) for sepsis by standard criteria, and collected standardised clinical data.

    Main outcome measures:
     Population-based incidence of community-onset sepsis and severe sepsis requiring intensive care unit (ICU) admission; 28-day mortality rate and microbial epidemiology.

    Results:
     There were 1191 hospital admissions for sepsis in 1090 patients, of which 604 (50.7%) were Indigenous people; the average age was 46.7 years. The age-adjusted annual population-based incidence of sepsis was 11.8 admissions per 1000 (mortality rate, 5.4%), but for Indigenous people it was 40.8 per 1000 (mortality rate, 5.7%). For severe sepsis requiring ICU admission, the incidence was 1.3 per 1000 per year (mortality rate, 21.5%), with an Indigenous rate of 4.7 per 1000 (mortality rate, 19.3%).

    Conclusions:
     The incidence of sepsis in the tropical NT is substantially higher than that for temperate Australia, the United States and Europe, and these differences are mainly accounted for by the high rates of sepsis in Indigenous people. The findings support strategies to improve housing and access to health services, and reduce comorbidities, alcohol and tobacco use in Indigenous Australians. The burden of sepsis in indigenous populations worldwide requires further study to guide appropriate resourcing of health care and preventive strategies.

    Original languageEnglish
    Pages (from-to)519-524
    Number of pages6
    JournalMedical Journal of Australia
    Volume194
    Issue number10
    Publication statusPublished - 2011

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    Northern Territory
    Sepsis
    Mortality
    Incidence
    Population Groups
    Intensive Care Units
    Preventive Health Services
    Population
    Tobacco Use
    Health Services
    Comorbidity
    Epidemiology
    Cohort Studies

    Cite this

    Davis, Joshua S. ; Cheng, Allen C. ; McMillan, Mark ; Humphrey, Alex B. ; Stephens, Dianne P. ; Anstey, Nicholas M. / Sepsis in the tropical top end of Australia's Northern territory : Disease burden and impact on indigenous Australians. In: Medical Journal of Australia. 2011 ; Vol. 194, No. 10. pp. 519-524.
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    abstract = "Objective: To describe the clinical and epidemiological features of sepsis and severe sepsis in the population of the tropical Top End of the Northern Territory of Australia and compare these with published estimates for temperate Australia, the United States and Europe.Design, setting and participants: Prospective cohort study in the major hospital for tropical NT, a region where 27{\%} of the population are Indigenous. We screened all adult (≥ 15 years) acute hospital admissions over a 12-month period (6 May 2007 – 5 May 2008) for sepsis by standard criteria, and collected standardised clinical data.Main outcome measures: Population-based incidence of community-onset sepsis and severe sepsis requiring intensive care unit (ICU) admission; 28-day mortality rate and microbial epidemiology.Results: There were 1191 hospital admissions for sepsis in 1090 patients, of which 604 (50.7{\%}) were Indigenous people; the average age was 46.7 years. The age-adjusted annual population-based incidence of sepsis was 11.8 admissions per 1000 (mortality rate, 5.4{\%}), but for Indigenous people it was 40.8 per 1000 (mortality rate, 5.7{\%}). For severe sepsis requiring ICU admission, the incidence was 1.3 per 1000 per year (mortality rate, 21.5{\%}), with an Indigenous rate of 4.7 per 1000 (mortality rate, 19.3{\%}).Conclusions: The incidence of sepsis in the tropical NT is substantially higher than that for temperate Australia, the United States and Europe, and these differences are mainly accounted for by the high rates of sepsis in Indigenous people. The findings support strategies to improve housing and access to health services, and reduce comorbidities, alcohol and tobacco use in Indigenous Australians. The burden of sepsis in indigenous populations worldwide requires further study to guide appropriate resourcing of health care and preventive strategies.",
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    Sepsis in the tropical top end of Australia's Northern territory : Disease burden and impact on indigenous Australians. / Davis, Joshua S.; Cheng, Allen C.; McMillan, Mark; Humphrey, Alex B.; Stephens, Dianne P.; Anstey, Nicholas M.

    In: Medical Journal of Australia, Vol. 194, No. 10, 2011, p. 519-524.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Davis, Joshua S.

    AU - Cheng, Allen C.

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    N2 - Objective: To describe the clinical and epidemiological features of sepsis and severe sepsis in the population of the tropical Top End of the Northern Territory of Australia and compare these with published estimates for temperate Australia, the United States and Europe.Design, setting and participants: Prospective cohort study in the major hospital for tropical NT, a region where 27% of the population are Indigenous. We screened all adult (≥ 15 years) acute hospital admissions over a 12-month period (6 May 2007 – 5 May 2008) for sepsis by standard criteria, and collected standardised clinical data.Main outcome measures: Population-based incidence of community-onset sepsis and severe sepsis requiring intensive care unit (ICU) admission; 28-day mortality rate and microbial epidemiology.Results: There were 1191 hospital admissions for sepsis in 1090 patients, of which 604 (50.7%) were Indigenous people; the average age was 46.7 years. The age-adjusted annual population-based incidence of sepsis was 11.8 admissions per 1000 (mortality rate, 5.4%), but for Indigenous people it was 40.8 per 1000 (mortality rate, 5.7%). For severe sepsis requiring ICU admission, the incidence was 1.3 per 1000 per year (mortality rate, 21.5%), with an Indigenous rate of 4.7 per 1000 (mortality rate, 19.3%).Conclusions: The incidence of sepsis in the tropical NT is substantially higher than that for temperate Australia, the United States and Europe, and these differences are mainly accounted for by the high rates of sepsis in Indigenous people. The findings support strategies to improve housing and access to health services, and reduce comorbidities, alcohol and tobacco use in Indigenous Australians. The burden of sepsis in indigenous populations worldwide requires further study to guide appropriate resourcing of health care and preventive strategies.

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