Sepsis and acute kidney injury-related mortality in the U.S.: National trends and disparities (1999–2023)

This study aimed to assess national mortality trends involving concurrent sepsis and acute kidney injury (AKI) documented on death certificates in the United States, with a focus on identifying temporal changes and disparities across demographic and geographic subgroups. Using Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research's Multiple Cause-of-Death dataset (1999-2023), mortality trends in adults aged ≥ 25 years with concurrent sepsis and AKI documented on death certificates, identified via International Classification of Diseases, 10th Revision codes. Age-adjusted mortality rates were computed and stratified by sex, race/ethnicity, census region, urbanization, and age. Joinpoint regression analysis identified significant trend changes over time. 412,494 deaths involving concurrent sepsis and AKI were identified. Age-adjusted mortality rates rose from 3.51 to 13.11 per 100,000, with the sharpest increase occurring post-2018 (average annual percentage change: 6.43%, 95% confidence interval: 4.07-8.86). Mortality disproportionately affected older adults (≥ 65 years), males, Black and American Indian/Alaska Native populations, and rural residents. The South had the highest regional mortality, while the West experienced the steepest growth. Mortality rates increased substantially during the pandemic period. Geographic, racial, and socioeconomic disparities persisted throughout the study period. Mortality involving concurrent sepsis and AKI documented on death certificates increased over the study period, with accelerating trends and inequitable distribution among vulnerable groups. Pandemic-period increases may have contributed to the observed rise in mortality. These findings highlight the importance of improving early recognition, equitable healthcare access, and prevention strategies among high-risk populations.