Gender-Stratified analysis of sepsis mortality in cancer: a 45-Year Population-Based cohort study

Background Sepsis is a major cause of death in cancer patients, yet its variation by cancer type and patient characteristics remains underexplored. We analyzed sepsis mortality in a large cancer cohort, focusing on gender and demographic disparities. Methods We analyzed 3,577,100 cancer cases from the SEER database (1975–2019), and calculated the standardized mortality ratio (SMR) and absolute excess risk (AER), stratified by gender, cancer type, and demographics. Logistic regression identified factors linked to sepsis mortality odds, while Cox proportional hazards models evaluated their time-dependent effects. Results Cancer patients experienced an excess sepsis mortality rate of 1.68 deaths per 10,000 person-years compared to the general population. Among 11,926 cancer patients who died from sepsis (0.39% of 3.07 million cases), males had consistently higher mortality than females. Risk was highest in older adults, Black, unmarried or widowed males with high-grade cancer. Liver and pancreatic cancers showed the highest SMR and AER, followed by stomach, lung, and hematologic cancers, whereas breast and prostate cancers had lower mortality. Patients diagnosed within the first year of cancer diagnosis faced the greatest risk. Logistic regression identified protective factors including female sex, younger age, localized cancer, marriage, and radiation therapy, while Cox models highlighted the time-dependent protective effects of these factors. Conclusions Sepsis mortality varied significantly by gender, cancer type, and demographic characteristics. These findings emphasize the need for gender-specific and personalized management strategies to reduce sepsis mortality in high-risk cancer patients.