Abstract
Sepsis is one of the leading causes of death in the United States. We aimed to explore long term demographic and geographical trends of sepsis-related mortality in the United States from 1999 to 2022. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) national database was utilized to analyze differences in mortality associated with sepsis. Age-adjusted mortality rates (AAMR) were calculated, and Joinpoint Regression Program was used to determine trends for mortality. The results demonstrated that 4,177,071 deaths occurred during the study and that mortality increased for most demographic and geographic groups. Sepsis associated mortality did not witness any dramatic change from an AAMR of 77.51 in 1999 to 76.1 in 2019 but saw an increase of 30.22% from 2019 to 2021 which was primarily driven by associated COVID- 19 infections. Demographic and geographical disparities persisted with Men, NH African American and NH American Indians and Alaskan Natives, census region south having worse AAMRs. COVID- 19 contributed to around 1/6 th of sepsis associated deaths in US between 2020 and 2022 and accounted for most of the excess sepsis associated mortality during the pandemic.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12879-025-10921-7.
Keywords: CDC WONDER database, United States, Sepsis, Mortality trends, Demographic
Introduction
Sepsis is defined by the Centers for Disease Control and Prevention (CDC) as the body’s extreme response to an infection and is a life-threatening medical emergency [1]. Sepsis is due to activation of inflammatory components of the immune system, leading to vasodilation and leakage of intravascular fluid into surrounding tissue. The subsequent intravascular hypovolemia can lead to thrombosis, shock, and organ dysfunction. The CDC also states that one in three people who die in the hospital setting had sepsis during their hospitalization, further proving the lethality of this diagnosis.
One previous study showed that from 2005 to 2018, the sepsis-related mortality rates remained stable over the years, elucidating the difficulties in treating sepsis [2]. Furthermore, disparities were present in the demographic categories of race and sex. Sepsis-related mortality rates were increased overall in Black, Native American, and Hispanic patients compared to non-Hispanic (NH) White patients. Over time, however, sepsis-related mortality rates declined in Black and Hispanic patients but increased in NH White and Native American patients. Regarding sex, males were noted to have higher mortality rates related to sepsis (57 deaths per 100,000) compared to females (45.1 deaths per 100,000) [2]. Though an understanding of sepsis-related mortality regarding race and gender has been made over time, other variables that may contribute to mortality caused by sepsis, such as regional variations, need to be studied. Thus, this study utilized information from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) national database to better understand the demographic and regional factors that may affect mortality in patients with sepsis from 1999 to 2022.
Methods
Study design
We identified sepsis-related deaths in the United States from 1999 to 2022, using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) [3]. Data on sepsis-related deaths were extracted using the Multiple Cause-of-Death Public Use Record and the CDC WONDER death certificate records. This database has also been utilized to analyze mortality related to common causes of death such as sepsis and chronic respiratory diseases in past [2, 4]. The International Classification of Diseases, 10 th Revision (ICD- 10), was used to identify sepsis-related mortality for this investigation, using the codes A40-A41 (Supplemental Table 1). The various common associated causes associated with sepsis-related deaths were also explored using ICD- 10 codes listed in supplemental Table 1. We restricted the age to ≥ 25 years since those under the age of 25 years are typically less affected by sepsis-related deaths. This study was exempt from our institutional review board’s evaluation since the CDC WONDER database only contains anonymized data.
Table 1.
Summary of changes in age adjusted mortality rate (AAMR) from 1999 to 2019 and 2019 to 2021 stratified by sex, race, census region and age groups
| 1999 AAMR (95% CI) | 2019 AAMR (95% CI) | AAPC from 1999 to 2019 (95% CI) | 2021 AAMR (95% CI) | Percentage change in AAMR from 1999 to 2019 (%) | Percentage change in AAMR from 2019 to 2021 (%) | |
|---|---|---|---|---|---|---|
| Overall | 77.5 (77.1 to 77.9) | 76.1 (75.8 to 76.5) | − 0.048 (− 0.21 to 0.10) | 99.1 (98.7 to 99.5) | − 1.81 | 30.22 |
| Sex stratified | ||||||
| Male | 89.6 (88.8 to 90.3) | 87.6 (87 to 88.1) | − 0.0013 (− 0.21 to 0.16) | 115.6 (114.9 to 116.2) | − 2.23 | 31.96 |
| Female | 69.2 (68.7 to 69.7) | 67.3 (66.9 to 67.8) | − 0.15 (− 0.37 to 0.049) | 86 (85.5 to 86.5) | − 2.75 | 27.79 |
| Race Stratified | ||||||
| NH American Indian or Alaska Native | 94.29 (86.94 to 101.64) | 99.91 (94.97 to 104.84) | 0.76* (0.38 to 1.3) | 146.99 (140.89 to 153.1) | 5.96 | 47.12 |
| NH Asian or Pacific Islander | 57.93 (55.42 to 60.44) | 46.81 (54.38 to 47.77) | − 0.70* (− 0.93 to –0.42) | 62.46 (60.85 to 63.52) | − 21.61 | 33.14 |
| NH Black or African American | 159.74 (157.7 to 161.78) | 111.45 (110.13 to 112.77) | − 1.6* (− 1.9 to –1.5) | 149.44 (147.91 to 150.96) | − 30.23 | 34.09 |
| NH White | 68.51 (68.09 to 68.94) | 73.81 (73.42 to 74.2) | 0.44* (0.24 to 0.58) | 93.8 (93.35 to 94.25) | 7.74 | 27.08 |
| Hispanic | 83.47 (81.47 to 85.48) | 69.1 (68.04 to 70.15) | − 0.64* (− 0.88 to –0.37) | 103.29 (102.06 to 104.52) | − 17.22 | 49.48 |
| Census Region | ||||||
| Northeast | 85.21 (84.28 to 86.15 | 70.86 (70.1 to 71.62) | − 0.87* (− 1.0 to –0.71) | 83.99 (83.16 to 84.82) | − 16.84 | 18.53 |
| Midwest | 69.57 (68.78 to 70.37) | 73.21 (72.49 to 73.93) | 0.40* (0.14 to 0.75) | 90.52 (89.72 to 91.33) | 5.23 | 23.64 |
| South | 87.24 (86.5 to 87.98) | 85.96 (85.37 to 86.54) | − 0.043 (− 0.17 to 0.089) | 116.72 (116.04 to 117.41) | − 1.47 | 35.78 |
| West | 61.69 (60.87 to 62.51) | 66.32 (65.65 to 66.99) | 0.47* (0.26 to 0.62) | 89.64 (88.86 to 90.42) | 7.51 | 35.16 |
| Age Groups | ||||||
| Young (25–44) | 8.48 (8.28 to 8.68) | 8.44 (8.24 to 8.63) | 0.59* (0.20 to 1.0) | 13.81 (13.56 to 14.06) | − 0.47 | 63.63 |
| Middle age (45–74) | 65.73 (65.17 to 66.29) | 70.11 (69.65 to 70.58) | 0.35* (0.23 to 0.46) | 98.79 (98.24 to 99.33) | 6.66 | 40.91 |
| Elderly (≥ 75) | 474.58 (471.24 to 477.92) | 439.27 (436.57 to 441.97) | − 0.36* (− 0.58 to –0.18) | 522.38 (519.39 to 525.37) | − 7.44 | 18.92 |
*Indicates the APC is significant from 0
Demographic and geographical study groups
We extracted data on sepsis-related deaths from the years 1999–2022, which included data on gender, race and ethnicity, age, and region in the United States. The racial groups analyzed in this study were non-Hispanic (NH) Black/African American, NH American Indian/Alaskan Native, NH White, NH Asians or Pacific Islanders, and Hispanic as self-identified on the database. We analyzed gender in two groups, male and female, as written in the CDC WONDER database. Age groups were divided into three categories: young (25–44 years), middle aged (45–74 years), and elderly (75 + years). The categories of census region were divided by the CDC WONDER Census Bureau classifications of Midwest, West, East, and South. The State level data was analyzed for each of the 50 US States.
Statistical analysis
Sepsis-related crude mortality rates (CMR) were calculated by dividing the number of sepsis-related deaths by the corresponding United States population. In addition, age-adjusted mortality rates (AAMR) were also calculated. AAMR were standardized using the 2000 United States standard population [5]. Joinpoint Regression Program was used to determine trends in mortality within the years 1999–2022 by identifying significant changes in annual mortality trends over time [6]. The software fits models of linear segments in which significant temporal variation occurred. Annual percentage change (APC) with 95% confidence intervals (CIs) for the AAMRs were calculated for each identified segment. The Monte Carlo permutation test was utilized to identify changes in trends in annual percentage change (APC) with 95% CIs. The weighted average of the APCs was reported as average annual percentage changes (AAPCs) with 95% CIs as a summary of the reported mortality trend for the entire study period (1999–2022). APC and AAPCs were considered to increase or decrease if the slope pertaining to the data for mortality was significantly different over time from zero using a 2-tailed t-test. Statistical significance was set at p ≤ 0.05 for this investigation (represented by an asterisk ‘*’ in results and figures).
The impact of the COVID- 19 pandemic was identified using percentage change (PC) in AAMR from 2019 to 2021 (the year with highest sepsis associated AAMR) and was compared with PC from 1999 to 2019 (Table 1). Sensitivity analysis was performed using sepsis as the underlying cause of death. Sepsis and COVID- 19 associated deaths and AAMR were also calculated along with sepsis deaths without associated COVID- 19 deaths for 2020–2022. We also extracted and analyzed the most common sepsis associated causes of deaths over time from 1999–2001 to 2017–2019 (pre-pandemic) to 2020–2022 (during pandemic).
Results
Figures 1, 2, 3, 4, 5, 6, 7 and 8, Table 1 summarize the findings of our study. Supplemental tables and figures contain supporting data.
Fig. 1.
Age-adjusted mortality rates for males and females in the United States from the years 1999–2022. *Indicates the APC is significantly different from 0
Fig. 2.
Age-adjusted mortality rates for sepsis stratified by race between 1999 and 2022. *Indicates the APC is significantly different from 0
Fig. 3.
Stratified data by young (25–44 years), middle age (45–74 years), and elderly (≥ 75 years) age groups regarding mortality rates related to sepsis in the United States between 1999 and 2022. *Indicates the APC is significantly different from 0
Fig. 4.
Age adjusted mortality rates related to sepsis stratified by United States Census Region from the years 1999–2022. *Indicates the APC is significantly different from 0
Fig. 5.
Maps of state level changes in AAMR a) from 1999 to 2019 b) from 2019 to 2021
Fig. 6.
State level changes in AAMR a) from 1999 to 2019 b) from 2019 to 2021
Fig. 7.
Most common sepsis associated causes of death in 1999–2001, 2017–2019, and 2020–2022
Fig. 8.
Sensitivity analysis using sepsis as the underlying cause of death, Sepsis + COVID- 19 deaths, and sepsis excluding COVID- 19 deaths for comparison: a) AAMR, b) Crude number of deaths
Overall
Between 1999 and 2022, 4,177,071 deaths occurred in the study population due to sepsis complications (Supplemental Table 2). From 1999 to 2019, the AAPC was –0.05 (95% CI –0.21 to 0.10) with a PC in AAMR of –1.81%. From 2019 to 2021, however, the PC in AAMR was 30.22% (Table 1; Fig. 1; Supplemental Table 2,3).
Demographic differences
Gender stratified
Upon stratifying sepsis mortality data by gender, it was revealed that men consistently had a higher age adjusted mortality rate than women. In women, the AAPC from 1999 to 2019 was –0.15 (95% CI − 0.37 to 0.05) and the PC in AAMR was –2.75%. From 2019 to 2021, the PC in AAMR in women was 27.29%. For men, the AAPC from 1999 to 2019 was –0.0013 (95% CI − 0.21 to 0.16) and the PC in AAMR was –2.23%. The PC in AAMR from 2019 to 2021 in men was 31.96% (Table 1; Fig. 1; Supplemental Table 3).
Race stratified
The Black or African American group experienced the highest AAMR compared to all other ethnic groups studied between 1999 and 2021. From 1999 to 2019, the AAPC was –1.6* (95% CI –1.9 to –1.5). Despite having the highest AAMR in this time frame, the Black or African American group had the lowest PC in AAMR at –30.23%. In 2019 to 2021, the PC in AAMR was 34.09%. The American Indian or Alaska Native group had the second highest AAMR from 1999 to 2019 with an AAPC of 0.76* (95% CI 0.38 to 1.3) and a PC in AAMR of 5.96%. The PC in AAMR from 2019 to 2021 was 47.12%. The Hispanic group had the third highest AAMR from 1999–2019, with an AAPC of –0.64* (95% CI –0.88 to –0.37) and a PC in AAMR of –17.22%. The PC in AAMR for 2019 to 2021 was 49.48%. The NH White group had the second lowest AAMR with an AAPC of 0.44* (95% CI 0.24 to 0.58) from 1999 to 2019. The PC in AAMR was 7.74% from 1999 to 2019, and 27.08% from 2019 to 2021. The Asian or Pacific Islander group had the lowest AAMR of all the race groups. The AAPC from 1999 to 2019 was –0.70* (95% CI –0.93 to –0.42), the PC in AAMR during this time frame was –21.61%, and the PC in AAMR from 2019 to 2021 was 33.14%. (Table 1; Fig. 2; Supplemental Table 4).
Age group stratified
All age groups experienced an increase in AAMR from the years 2019 to 2021. The elderly group (≥ 75 years) had an AAPC of –0.36* (95% CI –0.58 to –0.18) with a PC in AAMR of –7.44% from 1999 to 2019. From 2019 to 2021, the PC in AAMR was 18.92%, reflecting the increase in AAMR during this time. The two other age groups studied also experienced a similar increase. The middle age group (45 to 74 years) had an AAPC of 0.35* (95% CI 0.23 to 0.46) with a PC in AAMR of 6.66% from 1999 to 2019. In 2019 to 2021, the PC in AAMR was 40.91%. The young group (25 to 44 years) had an AAPC of 0.59* (95% CI 0.20 to 1.0) with a PC in AAMR of –0.47% from 1999 to 2019. The PC in AAMR from 2019 to 2021 was 63.63% (Table 1; Fig. 3; Supplemental Table 5).
Regional variation
Census region differences
All census regions (Midwest, West, Northeast, and South) experienced an increase in AAMR from the years 2019 to 2021. From 1999 to 2019, the South had an AAPC of –0.043 (95% CI –0.17 to 0.089) and a PC in AAMR of –1.47%. The PC in AAMR from 2019 to 2021 was 35.78%. The Northeast had an AAPC of –0.87* (95% CI –1.0 to –0.71) from 1999 to 2019, with a PC in AAMR of –16.84%. The PC in AAMR from 2019 to 2021 was 18.53%. In the West, the AAPC was 0.47* (95% CI 0.26 to 0.62) with a PC in AAMR of 7.51%. The PC in AAMR from 2019 to 2021 was 35.16%. Finally, in the Midwest, the AAPC was 0.40* (95% CI 0.14 to 0.75) from 1999 to 2019, the PC in AAMR from 1999 to 2019 was 5.23%, and the PC in AAMR from 2019 to 2021 was 23.64% (Table 1; Fig. 4; Supplemental Table 6).
State level changes
Prior to the COVID- 19 pandemic, more states had a decreased AAMR trend compared to the start of the COVID- 19 pandemic. After the COVID- 19 pandemic, the majority of the United States experienced an increase in AAMR with the highest being Kentucky which had an AAMR of 45.99 from 2019–2022. On the other end of the spectrum, the State of Maine experienced a decline in AAMR at –9.97 from 2019–2022 (Figs. 5 and 6).
Most common associated causes of death
Pneumonia remained the most common cause of sepsis associated deaths. From 1999–2001, pneumonia accounted 20.77% of all sepsis related deaths and increased to 27.63% from 2020–2022. Also, there was a decrease in the percentage of sepsis deaths associated with chronic lower respiratory diseases, from 7.15% in 1999–2001 to 1.50% in 2020–2022. COVID- 19 was associated with 15.14% of all sepsis related deaths (Fig. 7; Supplemental Table 7).
Changes during COVID- 19 pandemic (2019 to 2021) and sensitivity analysis
The COVID- 19 pandemic resulted in a 30.22% increase in sepsis-related AAMR from 2019 to 2021 (the year with the most sepsis associated deaths); this increase was seen among all groups as shown in Figs. 1, 2, 3, 4, 5, 6, 7 and 8 as well as Table 1 which compares the percentage change from 1999 to 2019 to that of 2019 to 2021.
When COVID − 19 associated deaths were excluded from all sepsis deaths, the AAMR remained similar to the long-term trend signifying that almost all the excess AAMR was driven by COVID- 19 associated sepsis mortality (Fig. 8; Supplemental Table 8,9).
Discussion
Sepsis is a life-threatening complication that affects patients in both inpatient and outpatient settings. This study demonstrates several findings regarding sepsis-related mortality rates in the United States from 1999 to 2022. First, men and women both experienced significant increases in mortality rates, with men experiencing higher rates compared to women. Second, the differences in mortality rates among different ethnicities were prevalent, and it was found that African Americans experienced the highest mortality rates overall due to sepsis. Lastly, geographic differences based on census regions were found, with the highest mortality related to sepsis in the South.
Gender
Evaluation of AAMR in sepsis-related mortality demonstrate that men and women had an increase in mortality rates from 1999–2022, but men had overall higher rates of mortality. This can likely be attributed to men being more likely than women to engage in high-risk behaviors, such as smoking, drinking, and using illicit drugs. Men are also less likely to utilize healthcare services such as emergency department visits and preventative health care visits. [7] Another study demonstrates that men are also more likely to have more lethal conditions, such as heart disease, stroke, and diabetes, which could be comorbid with sepsis [8]. This is especially pertinent considering that these lethal conditions can cause greater susceptibility to infection and sepsis or lead to hospitalizations that expose patients to iatrogenic infections. It is important to understand how men and women are both facing increased risk of susceptibility to sepsis as time progresses as well as address the behaviors that may put members of both sexes at risk for sepsis, particularly men more so than women.
Race
The AAMR in sepsis-related deaths closely mirror the racial inequalities in the United States. Minority racial groups such as the African American, the Native American, and the Hispanic populations had the highest AAMRs between the years of 1999 to 2019 compared to the NH White population. All racial groups experienced an increased in AAMR during the COVID- 19 pandemic. Between 1999 and 2019, minority groups with the highest AAMR could be explained by socioeconomic status, in which minorities in the United States are generally in a lower socioeconomic status (SES) [9, 10]. Perhaps the additional strain of the pandemic on United States’ social support systems as well as the strain to the hospital system resources may have led to diminishing health outcomes in regards that go beyond COVID- 19 itself, including sepsis [11, 12]
Previously published epidemiological studies have demonstrated that NH White patients experience disproportionately better outcomes with sepsis compared to other racial groups. The NH White population had the lowest overall AAMR of all racial groups during the study period; however, this population experienced a significant APC from 2012 to 2019 [13]. The APC from 2012 to 2019 likely cannot be explained by a single factor [14]. Some factors that may play a role in this increase in sepsis-related deaths in the NH White population include the opioid pandemic and other substance abuse. In one study conducted from epidemiological data in Michigan, 74.7% of sepsis cases in the setting of substance abuse were attributed to the NH White population [15].
Age groups
In our analysis of varying age groups, the elderly group (≥ 75 years) had the highest AAMR, followed by the middle-aged group (45–75 years), and lastly, the young age group (25–44 years). This trend in increased mortality with advanced age is not surprising. Interestingly, there was an increase in APC from 2014 to 2022 for the young age group. The rise in sepsis mortality in the younger adult populations may be in part due to an increase in IV drug usage (IVDU). One study investigating the relationship between drug abuse and infective endocarditis found that drug abuse-related cases of infective endocarditis essentially doubled between 2002 and 2016 [16]. The average age of those with drug abuse-related endocarditis was 38 years old compared to non-drug abuse-related endocarditis at 70 years old [16]. IVDU can serve as a nidus for bacteremia and, by extension, sepsis in the young population. This increase in drug abuse-related infective endocarditis cases could be an indicator that rising drug abuse in young people has contributed to a rise in sepsis mortality in the young age range.
Regional variations
We evaluated AAMR in the setting of sepsis based on the four major United States regions: the South, Midwest, West, and Northeast. The region with the greatest AAMR was the South. A previously published study that investigated sepsis-related deaths also found that mortality was highest in the American South, particularly in non-metropolitan areas [17]. This adds to our understanding that those who reside in more rural areas, the American South, for example, are at a disadvantage in terms of access to healthcare. However, this concept is challenged by our data, which shows that the Northeast region has the second highest AAMR of all the US regions. The Northeast is a region with a high density of major metropolitan areas; however, limited access to care in more rural areas, such as in the Appalachian states, could contribute to the high AAMR. Another contributing factor could be low-income areas in large metropolitan areas. For example, the same study found that in Baltimore, Maryland, sepsis-related deaths were significantly higher in low-income areas compared to high-income regions [17]. These findings demonstrate that socioeconomic status is an essential factor in sepsis-related outcomes, including mortality.
COVID- 19
Across the different demographics analyzed in this study, there was a universal increase in sepsis-related mortality from 2019 to 2022. This timeframe coincides with the recent COVID- 19 pandemic, which likely magnified the number of patients passing away from sepsis. This is consistent with our sensitivity analysis, in which the COVID- 19 pandemic appeared to contribute to the increase in sepsis-related deaths from 2019–2022. One study identified COVID- 19 as an independent risk factor for increased in-hospital mortality in septic patients [18]. Another study, however, discusses that the occurrence of sepsis among decedents with COVID- 19 in the US may be vastly underestimated as so many cases of sepsis may not have been accounted for. This may be due to the clinicians being less certain about their diagnostic skills in the face of the novel COVID- 19 pandemic [19].
Sepsis and associated causes of death
In our analysis of sepsis mortality and associated causes of death, several findings emerged, including an increase in contribution from pneumonia both before and during the pandemic from 20.77% in 1999–2001 to 23.71% in 2017–2019 and further to 27.63% in 2020–2022. Perhaps the rise in COVID- 19 infections, in conjunction with the strain the pandemic imposed on the US healthcare system, led to an increase in deaths from sepsis in the setting of pneumonia [11]. This rise parallels the contribution from heart failure, which rose from 8.08% from 1999–2001, 9.64% from 2017–2019, and 9.87% from 2020–2022. In the United States, there has been an increase in both heart failure deaths and heart failure deaths with concurrent sepsis over the past two decades [20, 21]. Interestingly, there was a sharp decline in deaths due to sepsis associated with chronic lower respiratory tract diseases in 2020–2022 at 1.50% of all sepsis deaths compared to 2017–2019 at 7.49% of all sepsis deaths. It can be speculated that this sharp decline in deaths due to sepsis associated with chronic lower respiratory tract diseases was due to those with chronic lower respiratory tract diseases are at a higher risk of severe COVID- 19 infection and likely dying from a severe COVID- 19 infection rather than from their chronic disease [22]. In addition, there was an initial increase in mortality of urinary tract infections (UTI) in the setting of sepsis from 7.75% in 1999–2001 to 11.26% in 2017–2019, followed by a slight decrease to 11.02% from 2020–2022.
Strengths and limitations
This study’s strengths were primarily based on the utilization of the CDC WONDER database, which captures almost all US mortality, thus allowing us to provide a comprehensive analysis of trends and differences in mortality rates due to sepsis, associated comorbidities and causes of deaths, and the changes due to pandemic. The limitations include misclassification bias due to its reliance on ICD- 10 codes. It also lacks information on potential confounders. Lastly, the data regarding Asians and Pacific Islanders as separate racial groups were available only from 2018 onward.
Conclusion
Sepsis associated mortality did not witness any dramatic change from 1999 to 2019 but saw a large jump from 2019 to 2021 which was primarily driven by associated COVID- 19 infections. Demographic and geographical disparities persisted with Men, NH African Americans and NH American Indians, and Alaskan Natives, and the census region south having worse AAMRs. COVID- 19 contributed to around 1/6 th of Sepsis-associated deaths in the US between 2020 and 2022. Perhaps the disparities in healthcare outcomes, including outcomes in the setting of sepsis, could be best explained by the inequities of socioeconomic status. Further studies are needed to investigate factors leading to time trends reported in the present study.
Supplementary Information
Acknowledgements
Not applicable.
Abbreviations
- AAMR
Age-adjusted mortality rates
- APC
Annual percent change
- CDC
Centers for Disease Control and Prevention
- CDC WONDER
Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research
- CI
Confidence interval
- COVID- 19
Coronavirus Disease 2019
- ICD- 10
International Classification of Diseases, 10 th Revision
- IVDU
Intravenous drug usage
- NH
Non-Hispanic
- PC
Percent change
- SEC
Socioeconomic status
- US
United States
- UTI
Urinary tract infection
Authors’ contributions
R.M. and J.L. wrote the main manuscript. N.B. and A.A. edited the drafts of the manuscript. A.A. ran the statistical analysis. R.M. and J.L. made the figures and tables in the manuscript. A.T., M.M., and A.S. reviewed and provided feedback on the manuscript. All authors reviewed the final manuscript.
Funding
Not applicable.
Data availability
The data in study has been provided within the manuscript or in the supplementary files section.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Committee on Publication Ethics (COPE) guidelines. This study was exempt from our institutional review board’s evaluation since the CDC WONDER database only contains anonymized data.
Consent for publication
All authors of this manuscript consented to publication in BMC Infectious Diseases.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Data Availability Statement
The data in study has been provided within the manuscript or in the supplementary files section.