Long-Term Trends in Sepsis Mortality Among Older U.S. Adults with Chronic Kidney Disease, 1999–2023

Background: Sepsis causes 1 in 3 U.S. hospital deaths, especially deadly among adults ≥65 with CKD, affecting over 30% of over-70s. Long-term trends in this group are understudied. This study examines the national mortality trends (1999–2023) among older U.S. adults with sepsis and CKD. Methods: We conducted a retrospective cohort study using the CDC WONDER database (1999–2023). Older adults with sepsis and CKD were identified using ICD-10 codes for sepsis (A40-41) and chronic kidney disease (N18). Mortality rates were stratified by geography and demographics. Age-adjusted mortality rates (AAMRs) per 100,000 and 95% confidence intervals were calculated. Annual percent change (APC) and average APC (AAPC) were derived using Joinpoint regression software to assess temporal trends. Results: Among 201,637 deaths from CKD and sepsis, 83.00% occurred in medical facilities. AAMRs rose from 14.45 (1999) to 20.68 (2023) (AAPC: 1.37%; 95% CI: 0.78-1.97). Men’s average AAMR (22.72) exceeded women’s (15.64). Non-Hispanic Whites had the highest AAPC, and Blacks had the highest AAMR. AAMRs were higher in metropolitan areas, with faster increases in non-metropolitan areas (available only for 1999-2020). The South had the highest average AAMR (19.94), while the Midwest recorded the steepest rise. Substantial variation in AAMRs was observed across U.S. states. Conclusion: Mortality involving sepsis among older adults with CKD increased between 1999 and 2023. Considerable demographic and geographic disparities were observed, underscoring the need for targeted interventions in high-risk populations.