Mortality trends in US women with concurrent sepsis and urinary tract infection

OBJECTIVE: Urinary tract infections (UTIs) are common among women and are a recognized source of sepsis, particularly among older adults. However, long-term national mortality trends among females with concurrent UTI and sepsis remain inadequately characterized. METHODS: A retrospective population-based analysis was conducted using US mortality records from 1999 to 2023. Decedents were females aged ≥25 years with death certificates documenting both UTI (ICD-10: N39.0) and sepsis (A40-A41). Age-adjusted mortality rates (AAMRs) were computed using the 2000 US standard population. Joinpoint regression was applied to estimate annual percent change (APC) and average annual percent change (AAPC). Stratification included age, race, region, state, and urbanization level. RESULTS: A total of 275 514 deaths were identified. The UTI-sepsis AAMR rose from 6.07 per 100 000 in 1999 to 9.65 per 100 000 in 2023 (AAPC 2.26%, 95% confidence interval [CI]: 1.68-2.84). A significant increase was observed from 1999 to 2014, with a slower subsequent rise and a notable acceleration after 2019. The highest mortality burden was observed among women aged ≥85 years, while the steepest relative increases occurred in middle-aged groups. The South exhibited the highest regional mortality. Non-Hispanic Black women showed persistently elevated rates. Non-metropolitan areas experienced higher and more rapidly increasing mortality than metropolitan areas. CONCLUSION: Mortality among US females with concurrent UTI and sepsis has increased over two decades, accompanied by widening age, racial, and geographic disparities. These trends underscore the need for targeted interventions.