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Comment & Response
August 28, 2018

Sepsis as a Cause of Infectious Disease Mortality

Author Affiliations
  • 1Epidemiological Service, Veneto Region, Padova, Italy
  • 2Italian National Institute of Statistics, Rome, Italy
JAMA. 2018;320(8):836-837. doi:10.1001/jama.2018.7941

To the Editor Dr el Bcheraoui and colleagues reported a decreasing trend over time and large geographical variability in mortality from infectious diseases in the United States between 1980 and 2014.1 One issue related to the adopted Global Burden of Diseases (GBD) approach is the identification and redistribution of “garbage codes,” which include codes for sepsis. Sepsis accounted for 1.5% of all deaths in the United States in 2015, ranking as the 11th leading cause of death.2 During 1999-2014, sepsis was reported in 6% of all US death certificates, irrespective of selection as the underlying cause (multiple cause data), with a 31% increase in the number of deaths with mention of sepsis during this period.3 Garbage code redistribution methods include proportional analysis, regression methods, and literature review.1,4 Given the large proportion of deaths from sepsis, the choice of the redistribution method will greatly affect the estimates of infectious diseases mortality.