Changes in Self-Rated Health After Sepsis in Older Adults: A Retrospective Cohort Study

Background: As more individuals survive sepsis, there is an urgent need to understand its effects on patient-reported outcomes. Research Question: What is the effect of sepsis on self-rated health, and what role, if any, does functional disability play in mediating this effect? Study Design and Methods: We conducted a survey- and administrative claims-based retrospective cohort study using the US Health and Retirement Study, a nationally representative cohort-based survey of older adults in the United States, from 2000 through 2016. We matched Medicare beneficiaries hospitalized with sepsis in 2000 to 2008 to nonhospitalized individuals. Self-rated health and functional disability were tracked biannually for 8 years. Differences in self-rated health between the cohorts were measured using mixed models with and without controlling for changes in functional disability. Results: Seven hundred fifty-eight individuals with sepsis were matched 1:1 to 758 nonhospitalized individuals, all aged 65 years and older. Among survivors, sepsis was associated with worse self-rated health in years 2 and 4 (adjusted absolute difference in self-rated health on a 5-point scale in year 2: −0.24 [95% CI, −0.38 to −0.10] and year 4: −0.17 [95% CI, −0.33 to −0.02]) but not in years 6 or 8. After accounting for changes in functional status, the association between sepsis and self-rated health was still present but reduced in year 2 (adjusted absolute difference in self-rated health, −0.18 [95% CI, −0.31 to −0.05]) and was not present in years 4, 6, or 8. Interpretation: Self-rated health worsened initially after sepsis but returned to the level of that of nonhospitalized control subjects by year 6. Mitigating sepsis-related functional disability may play a key role in improving self-rated health after sepsis.