Sepse no Ceará (2001–2022): análise da mortalidade e suas implicações dinâmicas espaço-temporais

Abstract

Introduction: Sepsis constitutes a clinical condition of high social, political, and economic relevance, and its effective management remains a major challenge for health systems. Objective: To characterize the epidemiological and spatiotemporal patterns of sepsis-related mortality in the state of Ceará, Brazil, between 2001 and 2022. Methods: All deaths of individuals older than 28 days that contained explicit mentions of “septicemia” in the ICD-10 codes were included, regardless of whether sepsis appeared as the underlying or an associated cause of death (multiple causes of death). The study comprised three sub-studies: (1) a cross-sectional descriptive study on sociodemographic and epidemiological characteristics of deaths; (2) an ecological time-trend analysis; and (3) an ecological study of spatiotemporal distribution. The analysis was based on publicly available secondary data. Results: A total of 1,099,725 deaths occurred in Ceará during the study period. Of these, 166,003 (15.1%) had sepsis recorded on the death certificate, and 18,949 (11.4%) were registered as the underlying cause of death. When sepsis was listed as an associated cause, the most frequent underlying cause was unspecified septicemia (A419), representing 79.8% of cases. Among deaths in which sepsis was the underlying cause, and after excluding redundant mentions, 1,474 distinct associated causes were identified. The most frequent were “Other specified general symptoms” (R688), with 3,447 occurrences (11.2%), and “Respiratory arrest” (R092), with 1,924 (6.2%). The mortality rate from sepsis showed an overall upward trend in the state. During the first decade of the time series, rates were relatively low (4.15 deaths per 100,000 inhabitants). However, between 2010 and 2015, a progressive increase was observed, with an average of 7.07 deaths per 100,000 inhabitants. After 2015, a sharper rise occurred, reaching an average of 11.50 per 100,000. The highest mortality rates were recorded between 2020 and 2021, with a peak in April 2021 (20.85 per 100,000 inhabitants). In the spatiotemporal analysis, 16 high-risk mortality clusters were identified between 2001 and 2012, encompassing 94 municipalities (51.08%). The most likely cluster (2008–2012; RR=1.76) included Fortaleza and 23 adjacent municipalities within a 49.59 km radius, covering a population of approximately 3,650,902 inhabitants. The second cluster (2007–2012; RR=1.68) was located in the southern region and comprised 12 municipalities within a 48.41 km radius. From 2013 to 2019, 16 high-risk clusters were again identified, covering 89 municipalities (48.36%). The most likely cluster (2017–2019; RR=1.56) once again encompassed Fortaleza and 19 neighboring municipalities within a 49.97 km radius, while the second (2015–2017; RR=1.92) included three municipalities in the southern region. The same spatial pattern persisted during the final period, with the most likely cluster identified in the Fortaleza region (2021; RR=1.63), consisting of eight municipalities within a 30.05 km radius. In the northern region, Cluster 2 (2021; RR=1.42) stood out, including 14 municipalities within a 41.86 km radius. Conclusion: Sepsis appears both as a final outcome and as a component of complex morbid processes. The multiple-cause-of-death approach revealed underlying comorbidities that would not have been detected by a single-cause analysis. Furthermore, sepsis mortality in Ceará exhibited an overall upward trend from 2001 to 2022, with significant changes across different temporal segments and the persistence of high-risk mortality clusters throughout the period.