Sex Differences in Risk Factors for Incident Sepsis Hospitalizations: A Prospective Cohort Study Using the UK Biobank

Background Sepsis is a leading cause of death worldwide. The presence of most chronic conditions and other lifestyle-related risk factors increase sepsis risk. Whether there are sex differences in risk factors associated with sepsis hospitalization is unknown.Methods A prospective cohort study included participants aged 40-69 years recruited to the UK Biobank between 2006 and 2010. Sepsis was identified from hospitalization records. Poisson regression was used to estimate sex-specific incidence. Cox proportional hazards models were used to estimate hazard ratios (HRs) and the women-to-men ratio of HRs (RHR) with 95% confidence intervals (CIs) for risk factors associated with an incident sepsis hospitalization.Results Of 490 783 participants, 21 468 (47.6% women) experienced an incident sepsis hospitalization. Age-standardized risk was higher in men than in women (40.2 vs 31.2 per 10 000 person-years; HR, 1.26 [95% CI, 1.23-1.29]). Chronic obstructive pulmonary disease (COPD) conferred the highest risk for sepsis hospitalization, with excess risk in women (RHR, 1.23 [95% CI, 1.10-1.38]). Dyslipidemia (RHR, 1.08 [95% CI, 1.02-1.16]), myocardial infarction (1.22 [1.05-1.41]), and smoking (1.19 [1.09-1.29]) were associated with excess risk of sepsis hospitalization in women, compared with men. Dementia was associated with more than twice the risk of sepsis hospitalization in men (HR, 2.21 [95% CI, 1.37-3.55]).Conclusions The risk of sepsis hospitalization was higher in the presence of most risk factors, with greater effects in women with a history of COPD, dyslipidemia, myocardial infarction, and smoking. Incorporating sex-specific risk factors in risk prediction modeling may facilitate targeted prevention efforts and support earlier recognition and treatment. Sepsis hospitalization was higher in the presence of most risk factors, with greater effects in women with a history of chronic obstructive pulmonary disease, dyslipidemia, myocardial infarction and smoking, compared with men.