Sepsis incidence and mortality in China, 1990–2021: analysis for the Global Burden of Disease Study

• Reconstructed China's sepsis burden using GBD 2021 and published China anchors • China had 6.77 million sepsis cases and 2.48 million deaths in 2021 • Age-standardised incidence and mortality declined from 1990 to 2021 • Absolute sepsis cases rose, while sepsis-related deaths declined modestly • Infection-attributed sepsis had the highest age-standardised burden in 2021 Sepsis, a life-threatening dysregulated host response to infection that causes organ dysfunction, remains a major source of preventable health loss worldwide. However, its burden in China has not been fully characterized. We therefore estimated sepsis incidence and mortality in China from 1990 to 2021 within the GBD 2021 framework. Using China-specific GBD 2021 anchor values together with publicly available GBD outputs, we reconstructed annual all-age sepsis incidence and mortality from 1990 to 2021 with piecewise log-linear interpolation between published anchor years. Broad cause-group burden was allocated using annual shares from the China GBD outputs. Because direct Chinese age-standardised anchor values were unavailable, age-standardised incidence and mortality were treated as sensitivity analyses. Piecewise linear and monotonic cubic Hermite (PCHIP) interpolation were also examined in sensitivity analyses. In 2021, China had an estimated 6,773,717 incident sepsis cases (95% uncertainty interval [UI] 4,828,778-9,275,569) and 2,480,000 sepsis-related deaths (2,080,000-2,950,000). From 1990 to 2021, absolute incident cases increased, sepsis-related deaths declined modestly, and age-standardised incidence and mortality fell substantially. Infection-attributed sepsis remained the largest contributor to mortality, while the burden was disproportionately concentrated in males and older adults. Sepsis remains a major source of health loss in China. Despite declining age-standardised rates, the absolute burden remains large, with infection-attributed sepsis continuing to drive the greatest share of mortality and with older adults, males, and people with chronic diseases bearing disproportionate risk.