title: Marital status and the epidemiology and outcomes of sepsis.
abstract: BACKGROUND
  Sepsis is a major public health problem. Social factors may affect health behaviors, economic resources, and immune response, leading to hospitalization for infection. This study examines the association between marital status and sepsis incidence and outcomes in a population-based cohort.
  
  
  METHODS
  We analyzed 1,113,581 hospitalizations in New Jersey in 2006. We estimated risk-adjusted incidence rate ratios (IRRs) for sepsis among divorced, widowed, legally separated, single, and married subjects using population data from the American Community Survey. We used multivariable logistic regression to estimate marital status-specific hospital mortality.
  
  
  RESULTS
  We identified 37,524 hospitalizations for sepsis, of which 40% were among married (14,924), 7% were among divorced (2,548), 26% were among widowed (9,934), 2% (763) were among legally separated, and 26% (9355) were among single subjects. The incidence of hospitalization for sepsis was 5.8 per 1,000 population. The age, sex, and race-adjusted IRR for hospitalization with sepsis was greatest for single (IRR = 3.47; 95% CI, 3.1, 3.9), widowed (IRR = 1.38; 95% CI, 1.2, 1.6), and legally separated (IRR = 1.46; 95% CI, 1.2, 1.8) subjects compared with married (referent). We observed that single men and women and divorced men had greater odds of in-hospital mortality compared with married men; widowed and legally separated men and all ever-married women had no excess mortality during hospitalization for sepsis.
  
  
  CONCLUSIONS
  Hospitalization for sepsis is more common among single, widowed, and legally separated individuals, independent of other demographic factors. Among patients hospitalized for sepsis, single and divorced men and single women experience greater hospital mortality, highlighting the need to characterize the potentially modifiable mechanisms linking marital status to its greater burden of critical illness.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Box 359762, Harborview Medical Center, Seattle, WA 98104, USA. seymoc@u.washington.edu
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seymour
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*