Sepsis epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Parth Vikram Singh, MBBS[3]; Jason Le, B.S.[4]
Synonyms and keywords: sepsis syndrome; septic shock; septicemia
Sepsis epidemiology and demographics
Global burden
- The most current systematic estimate from the Global Burden of Disease (GBD) 2021 analysis reported approximately 166 million sepsis cases and 21.4 million all-cause sepsis-related deaths in 2021, representing approximately 31.5% of all global deaths.[1]
- For comparison, the GBD 2017 analysis estimated 48.9 million cases and 11.0 million deaths, accounting for approximately 19.7% of global deaths. The estimates should be interpreted according to the year and methodology and should not be averaged across analyses.[2]
- Approximately 85% of the global sepsis burden occurs in low- and middle-income countries (LMICs); sub-Saharan Africa accounts for approximately 40% of cases worldwide. The pathogen spectrum and epidemiologic context differ substantially from those in high-income countries.[3][2]
- GBD estimates are modeled population-level estimates derived from available mortality and health-system data and should therefore be interpreted with uncertainty, particularly in settings with sparse primary epidemiologic data.[1][2]
Temporal trends and COVID-19
- From 1990 through 2017, age-standardized sepsis incidence and mortality declined by approximately 37% and 52.8%, respectively.[2][3]
- This long-term decline was interrupted in 2020-2021, with a substantial increase in sepsis-related mortality driven largely by the COVID-19 pandemic.[1][4]
- In the United States, age-adjusted sepsis mortality was approximately 77.5 per 100,000 in 1999 and 76.1 per 100,000 in 2019, followed by an approximately 30% increase from 2019 to 2021.[4]
- The effect of COVID-19 on sepsis epidemiology complicates comparisons between pre-pandemic and pandemic-era estimates.[4]
Age
- Sepsis incidence has a U-shaped (biphasic) age distribution: incidence is highest in children younger than 5 years, reaches a nadir during later childhood and adolescence, and rises exponentially beginning around age 60.[3]
- Approximately 26% of the 11 million sepsis deaths estimated for 2017 occurred in children younger than 5 years.[3]
- The absolute mortality burden is concentrated in older adults, particularly those aged 70 years and older, who had the highest sepsis-related mortality in 2021, with approximately 9.28 million deaths.[1][5]
- In older U.S. hospitalization data, in-hospital death occurred in approximately 20% of sepsis hospitalizations among patients aged 65 years and older compared with approximately 13% among those younger than 65 years.[3]
Sex
- Sex differences vary by outcome and data source. GBD 2017 reported slightly higher age-standardized incidence in females than males (716 vs 643 per 100,000).[2]
- U.S. mortality analyses consistently report higher sepsis-related mortality in men than women, including approximately 57 versus 45.1 deaths per 100,000.[6][4]
Race and ethnicity
- In U.S. mortality data, sepsis-related mortality is higher among non-Hispanic Black, American Indian/Alaska Native, and Hispanic populations than among White populations, with Black patients bearing the highest absolute mortality throughout 1999-2022.[6][4]
- Observed racial and ethnic differences in sepsis mortality should not be interpreted as intrinsic biologic differences. After adjustment for hospital characteristics, much of the Black-White and Hispanic-White in-hospital mortality gap narrows, implicating hospital-level factors and site of care as important contributors.[7]
United States burden
- In the United States, sepsis is present in approximately 1 in 3 patients who die in U.S. hospitals.[8]
- In the United States, sepsis accounts for an estimated 1.7 million adult hospitalizations and approximately 270,000-350,000 associated deaths annually.[9]
- Approximately 4.5%-6.7% of hospitalizations have been estimated to meet clinical/EHR-based sepsis criteria in contemporary surveillance studies; estimates vary substantially according to case definition and ascertainment method.[10][11]
Incidence by definition and data source
- Sepsis epidemiologic estimates depend strongly on the case definition and ascertainment method. Comparisons between studies should distinguish historical SIRS/severe sepsis definitions from current Sepsis-3 criteria and administrative coding from clinical or electronic-health-record surveillance.[3][11]
- In a prospective Swedish population study, Sepsis-3 sepsis incidence was 838 per 100,000 persons per year, approximately three times the incidence of severe sepsis at 276 per 100,000 persons per year. The difference was attributed largely to the broader organ-dysfunction criteria used by Sepsis-3.[12]
- Administrative coding may show increasing apparent sepsis incidence because of changes in recognition and coding practices; therefore, trends in coded cases should not automatically be interpreted as changes in true biological incidence.[3][11]
Comorbidity-associated epidemiology
- Sepsis incidence is substantially elevated in patients with immunocompromising and chronic medical conditions. More than 20% of U.S. adult sepsis hospitalizations occur in patients with cancer, and sepsis incidence is increased approximately 40-fold among patients receiving long-term hemodialysis.[3]
- Validated epidemiologic risk factors include older age, male sex, low body mass index, Black race, diabetes, COPD, cancer, kidney disease, postoperative infection, mechanical ventilation, corticosteroid use, prior hospitalization, and prior sepsis.[13]
- Detailed individual risk factors and their effect sizes are addressed in the Risk Factors microchapter.
Geographic differences
- Approximately 85% of sepsis cases and a disproportionate share of sepsis deaths occur in LMICs.[3][2]
- Sub-Saharan Africa accounts for approximately 40% of global sepsis cases. The infectious causes and pathogen spectrum in these settings differ substantially from those in high-income countries and include malaria, typhoid, dengue, HIV, and tuberculosis.[3]
- Geographic differences in sepsis burden should be interpreted in the context of health-system capacity, access to care, underlying disease prevalence, infection epidemiology, and differences in surveillance quality.[3]
Clinical epidemiologic considerations
- Interpret sepsis statistics according to the case definition and data source. Historical severe sepsis/SIRS-based estimates are not directly interchangeable with Sepsis-3 estimates, and administrative coding estimates are not equivalent to clinical/EHR surveillance estimates.[3][12][11]
- Heightened epidemiologic risk occurs at the extremes of age and in patients with major chronic or immunocompromising conditions, including cancer, dialysis dependence, COPD, and diabetes.[3][13]
- Older adults, particularly those aged 70 years and older, account for the largest absolute mortality burden.[1][5]
- Hospital-level disparities contribute to observed racial differences in sepsis mortality and should be considered when interpreting disparities and designing quality-improvement interventions.[7]
- The epidemiology of sepsis changed substantially during the COVID-19 pandemic, making direct comparisons between pre-pandemic and pandemic-era estimates potentially misleading.[1][4]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 GBD 2021 Global Sepsis Collaborators (2025). "Global, Regional, and National Sepsis Incidence and Mortality, 1990-2021: A Systematic Analysis". The Lancet Global Health. doi:10.1016/S2214-109X(25)00356-0. PMID 41135560 Check
|pmid=value (help). - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Rudd KE, Johnson SC, Agesa KM; et al. (2020). "Global, Regional, and National Sepsis Incidence and Mortality, 1990-2017: Analysis for the Global Burden of Disease Study". Lancet. 395 (10219): 200–211. doi:10.1016/S0140-6736(19)32989-7. PMID 31954465.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Meyer NJ, Prescott HC (2024). "Sepsis and Septic Shock". N Engl J Med. 391 (22): 2133–2146. doi:10.1056/NEJMra2403213. PMID 39774315 Check
|pmid=value (help). - ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Morrissey R, Lee J, Baral N; et al. (2025). "Demographic and regional trends of sepsis mortality in the United States, 1999-2022". BMC Infectious Diseases. 25 (1): 504. doi:10.1186/s12879-025-10921-7.
- ↑ 5.0 5.1 Woo HG, Kim S, Oh J; et al. (2026). "The economic value of preventing projected sepsis-related deaths among adults in 79 countries, 2000-2023, with projections to 2050: a modelling study". Critical Care. 30 (1): 288. doi:10.1186/s13054-026-06024-7.
- ↑ 6.0 6.1 Prest J, Sathananthan M, Jeganathan N (2021). "Current Trends in Sepsis-Related Mortality in the United States". Critical Care Medicine. 49 (8): 1276–1284. doi:10.1097/CCM.0000000000005017. PMID 34261926 Check
|pmid=value (help). - ↑ 7.0 7.1 Jones JM, Fingar KR, Miller MA; et al. (2017). "Racial Disparities in Sepsis-Related in-Hospital Mortality: Using a Broad Case Capture Method and Multivariate Controls for Clinical and Hospital Variables, 2004-2013". Critical Care Medicine. 45 (12): e1209–e1217. doi:10.1097/CCM.0000000000002699. PMID 28906287.
- ↑ Rhee C, Jones TM, Hamad Y; et al. (2019). "Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals". JAMA Netw Open. 2 (2): e187571. doi:10.1001/jamanetworkopen.2018.7571. PMID 30768188.
- ↑ Rhee C, Dantes R, Epstein L; et al. (2017). "Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014". JAMA. 318 (13): 1241–1249. doi:10.1001/jama.2017.13836. PMID 28903154.
- ↑ Mellhammar L, Wollter E, Dahlberg J; et al. (2023). "Estimating Sepsis Incidence Using Administrative Data and Clinical Medical Record Review". JAMA Network Open. 6 (8): e2331168. doi:10.1001/jamanetworkopen.2023.31168.
- ↑ 11.0 11.1 11.2 11.3 Shappell C, Rhee C, Klompas M (2023). "Update on Sepsis Epidemiology in the Era of COVID-19". Seminars in Respiratory and Critical Care Medicine. 44 (1): 173–184. doi:10.1055/s-0042-1759880. PMID 36646093 Check
|pmid=value (help). - ↑ 12.0 12.1 Ljungström L, Andersson R, Jacobsson G (2019). "Incidences of Community Onset Severe Sepsis, Sepsis-3 Sepsis, and Bacteremia in Sweden - A Prospective Population-Based Study". PLOS ONE. 14 (12): e0225700. doi:10.1371/journal.pone.0225700. PMID 31805110.
- ↑ 13.0 13.1 Qin C, Lin S, Pang L; et al. (2026). "Risk Factors for Sepsis: A Systematic Review and Meta-Analysis". Frontiers in Public Health. 14: 1790141. doi:10.3389/fpubh.2026.1790141. PMID 42433399 Check
|pmid=value (help).