Temporal Trends in Sepsis-Associated Mortality Among Older Adults with Chronic Kidney Disease: A CDC WONDER Analysis

Background

Sepsis and chronic kidney disease (CKD) are major causes of mortality in the U.S. However, national trends in mortality involving both conditions remain poorly defined.

Methods

This cross-sectional study analyzed CDC WONDER data (1999–2023) to examine mortality trends related to CKD–sepsis (ICD-10: N18, A40, A41) among U.S. adults aged 45 years or older. Age-adjusted and crude mortality rates (AAMRs, CMRs) were calculated per 100,000 population and stratified by gender, age, race, urbanization, region, state, place of death, and ICD-10 subcodes. Annual and average annual percentage changes (APCs, AAPCs) in trends were assessed using Joinpoint regression.

Results

CKD–sepsis mortality remained stable from 1999 to 2023, with AAMR rising from 7.5 to 9.0 per 100,000 by 2019 (APC = 0.60%, 95% CI: -0.21 to 1.51), then declining from 10.3 in 2020 to 9.7 in 2023 (APC = -2.6%, 95% CI: -6.96 to 1.81). Of 270,746 CKD–sepsis-related deaths, 51.5% were male, with consistently higher AAMRs and a significant rise through 2019. Black individuals consistently had the highest AAMRs throughout the study. From 1999 to 2019, rates declined across all racial groups except Whites. By 2023, Black AAMR (21.1) remained over twice that of Whites (8.0), Asian/Pacific Islanders (8.3), and Hispanics (10.4). The CMR gap between the 45-54 and ≥85 groups widened from a 9-fold to a 23-fold difference over the study period. DC had the highest AAMR (22.5), while Montana had the lowest (4.1). AAMRs in medium-sized and small, as well as non-metropolitan areas, rose significantly, surpassing those in large metropolitan areas. Regionally, the South had the highest AAMR throughout, increasing from 8.8 to 10.7. The majority (92.91%) of deaths were attributed to unspecified septicemia.

Conclusion

CKD–sepsis-related mortality remained relatively stable from 1999 to 2023, though certain populations, particularly males, older adults, Black individuals, and residents of the South, experienced consistently higher mortality rates.