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Original Research: CRITICAL CARE MEDICINE |

Marital Status and the Epidemiology and Outcomes of Sepsis

Christopher W. Seymour, MD; Theodore J. Iwashyna, MD, PhD; Colin R. Cooke, MD, MSc; Catherine L. Hough, MD, MSc; Greg S. Martin, MD, MSc, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Seymour and Hough), University of Washington, Seattle, WA; the Division of Pulmonary and Critical Care Medicine (Drs Iwashyna and Cooke), and the Robert Wood Johnson Clinical Scholar Program (Dr Cooke), University of Michigan, Ann Arbor, MI; and the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Martin), Emory University, Atlanta, GA.

Correspondence to: Christopher W. Seymour, MD, Division of Pulmonary and Critical Care Medicine, Box 359762, Harborview Medical Center, Seattle, WA 98104; e-mail: seymoc@u.washington.edu


This abstract was submitted for presentation at the American Thoracic Society International Meeting, New Orleans, LA, in May 2010.

Funding/Support: This study was supported in part by an extramural training grant from the National Institutes of Health [Grant T32 NIH/HL07287].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1289-1296. doi:10.1378/chest.09-2661
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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.

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