Sepsis, a life-threatening condition caused by the body’s dysregulated response to infection, remains one of the leading causes of preventable death worldwide. Although advances in infection control, intensive care, and antimicrobial therapy have improved survival in many countries, sepsis continues to place enormous pressure on healthcare systems because it can develop rapidly and disproportionately affects vulnerable populations. In China, the burden of sepsis has been difficult to fully characterize because sepsis is frequently recorded as an intermediate complication rather than the primary cause of death, limiting the availability of consistent long-term national statistics.
The research was led by Professor Hao Wang from the Department of Critical Care Medicine at Qilu Hospital of Shandong University, China. Using publicly available Global Burden of Disease (GBD) 2021 outputs together with China-specific anchor values, the researchers reconstructed annual sepsis incidence and mortality trends in China from 1990 to 2021. The study combined national incidence and mortality estimates with analyses of sex, age, and broad underlying disease categories, including infections, injuries, and non-communicable diseases. The researchers also performed sensitivity analyses using multiple interpolation approaches to ensure the robustness of the reconstructed national trends. Their findings were made available online in the Journal of Intensive Medicine on May 6, 2026.
The analysis estimated that China experienced approximately 6.77 million incident sepsis cases and 2.48 million sepsis-related deaths in 2021 alone. Although age-standardized incidence and mortality declined substantially between 1990 and 2021, while the absolute number of sepsis cases continued to rise alongside population aging and demographic change. The study also found that infection-attributed sepsis remained the largest contributor to mortality, while non-communicable disease-related sepsis became increasingly important over time.
“Males and older adults consistently carried the highest burden across most categories of sepsis ,” explained Prof. Wang. “ This suggests that demographic aging, chronic disease accumulation, and delayed healthcare access remain major drivers of severe infection outcomes in China.”
The findings revealed striking age-related differences in sepsis burden. Infection-related sepsis deaths remained substantial among children and older adults, while non-communicable disease-attributed sepsis deaths increased sharply with age and peaked among individuals aged 80–84 years. In contrast, injury-related sepsis accounted for only a relatively small fraction of total mortality across all age groups. The researchers noted that these patterns reflect China’s broader epidemiological transition, in which chronic illnesses such as diabetes, cardiovascular disease, kidney disease, and malignancy increasingly amplify vulnerability to severe infection and organ failure.
The study also highlighted persistent sex disparities. Across infection-, injury-, and chronic disease-related sepsis, males consistently showed higher age-standardized incidence and mortality than females. The researchers suggest that smoking exposure, occupational hazards, chronic cardiometabolic disease, delayed healthcare-seeking behavior, and biological differences in immune responses may all contribute to this imbalance.
“Our results show that reducing sepsis deaths will require more than better infection treatment alone ,” said Prof. Wang. “ Future prevention strategies must integrate chronic disease management, healthy aging programs, vaccination, infection surveillance, and early recognition of clinical deterioration. ”
Beyond its immediate public health implications, the study may influence future collaborations between critical care specialists, infectious disease researchers, epidemiologists, geriatricians, and chronic disease experts. In the short term, the findings could help policymakers prioritize high-risk populations for vaccination campaigns, antimicrobial stewardship programs, and rapid sepsis recognition pathways. Over the longer term, the data may support the development of more integrated healthcare systems capable of managing the combined pressures of aging populations, multimorbidity, and severe infection. The researchers also emphasized that future studies incorporating hospital-level datasets, provincial analyses, and pathogen resistance trends could further refine the understanding of China’s evolving sepsis burden.
In summary, the study provides one of the most comprehensive reconstructions of China’s sepsis burden from 1990 to 2021 within the GBD framework. While age-standardized incidence and mortality have declined, the overall burden remains extremely large, with infections continuing to dominate mortality and chronic diseases increasingly shaping risk. The findings underscore the urgent need for integrated prevention, earlier recognition, and targeted care strategies to reduce future sepsis-related deaths in China.
Reference
DOI: https://doi.org/10.1016/j.jointm.2026.04.004
About Professor Hao Wang from Qilu Hospital of Shandong University, China
Dr. Hao Wang is a professor and physician at Department of Critical Care Medicine, Qilu Hospital of Shandong University, China. His clinical and research interests include sepsis, septic shock, organ dysfunction, antimicrobial resistance, and organ-support therapies in critically ill patients. He previously served as visiting scholar at Hospital of the University of Pennsylvania. He has authored more than 50 publications with more than 1,600 citations and serves as reviewer for international medical journals. His research has been supported by national and provincial funding agencies in China, and he has received awards for excellence in critical care research and education.
Journal of Intensive Medicine
Observational study
People
Sepsis incidence and mortality in China, 1990–2021: analysis for the Global Burden of Disease Study
6-May-2026
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.