You are here

Article Text

Article menu
Download PDFPDF
Original research
Direct and indirect effects of socioeconomic status on sepsis risk and mortality: a mediation analysis of the HUNT Study
  1. Vilde Hatlevoll Stensrud1,2,
  2. Lise Tuset Gustad2,3,4,
  3. Jan Kristian Damås5,6,7,
  4. Erik Solligård2,8,
  5. Steinar Krokstad9,10,
  6. Tom Ivar Lund Nilsen1,11
  1. 1 Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
  2. 2 Deptartment of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
  3. 3 Faculty of Nursing and Health Sciences, Nord University - Levanger Campus, Levanger, Norway
  4. 4 Department of Medicine and Rehabilitation, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
  5. 5 Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
  6. 6 Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  7. 7 Department of Infectious Diseases, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
  8. 8 Department of Research and Development, Møre og Romsdal Hospital Trust, Ålesund, Norway
  9. 9 HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
  10. 10 Department of Mental Health Care and Substance Abuse, Nord-Trøndelag Hospital Trust, Levanger, Norway
  11. 11 Clinic of Anaesthesia and Intensive Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
  1. Correspondence to Vilde Hatlevoll Stensrud, Dept of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, 7034, Norway; vildehs{at}stud.ntnu.no

Abstract

Background Socioeconomic status (SES) may influence risk of sepsis and sepsis-related mortality, but to what extent lifestyle and health-related factors mediate this effect is not known.

Methods The study included 65 227 participants of the population-based HUNT Study in Norway linked with hospital records to identify incident sepsis and sepsis-related deaths. Cox regression estimated HRs of sepsis risk and mortality associated with different indicators of SES, whereas mediation analyses were based on an inverse odds weighting approach.

Results During ~23 years of follow-up (1.3 million person-years), 4200 sepsis cases and 1277 sepsis-related deaths occurred. Overall, participants with low SES had a consistently increased sepsis risk and sepsis-related mortality using education, occupational class and financial difficulties as indicators of SES. Smoking and alcohol consumption explained 57% of the sepsis risk related to low education, whereas adding risk factors of cardiovascular disease and chronic diseases to the model increased the explained proportion to 78% and 82%, respectively.

Conclusion This study shows that SES is inversely associated with sepsis risk and mortality. Approximately 80% of the effect of education on sepsis risk was explained by modifiable lifestyle and health-related factors that could be targets for prevention.

  • EPIDEMIOLOGY
  • Health inequalities
  • INFECTIONS
  • SOCIAL CLASS
  • EDUCATION

Data availability statement

Data may be obtained from a third party and are not publicly available. HUNT data cannot be made available in open repositories due to privacy regulations, but data can be reproduced and made available upon approval of applications to the HUNT Research Center, the Nord-Trøndelag Hospital Trust, and St. Olavs Hospital.

https://doi.org/10.1136/jech-2022-219825

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data may be obtained from a third party and are not publicly available. HUNT data cannot be made available in open repositories due to privacy regulations, but data can be reproduced and made available upon approval of applications to the HUNT Research Center, the Nord-Trøndelag Hospital Trust, and St. Olavs Hospital.

    View Full Text

    Footnotes

    • Twitter @lisetugu

    • Contributors ES and JKD initiated the study, and VHS acquired the data. TILN and VHS developed the study objectives. VHS analysed the data and drafted the manuscript. All authors interpreted the data, provided critical revisions and approved the final version of the manuscript for submission. TILN acts as a guarantor of the study.

    • Funding This work was supported by the Faculty of Medicine at the University of Science and Technology.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.