Elder nonsurvivors of sepsis die earlier during hospitalization,
while elder survivors more frequently require skilled nursing or
rehabilitative care after hospitalization.18 Therefore, health care
resource prioritization and polarization may be one reason for the
difference in sepsis mortality rates between elderly and younger
adult populations. In mainland China, the crude mortality did not
differ between geographic regions (east, central and west China), but
it did differ between urban and rural areas in 2003. A possible reason
for this finding could be the difference in economic and health care
resource development between rural and urban areas. However, the
dramatic decline in the mortality in small and medium-sized cities
and rural areas might also be attributed to the ‘‘Surviving Sepsis
Campaign’’ that issued the first national guidelines for treatment of
multiple organ dysfunction syndrome and severe sepsis in 2007.19
Subsequently, the guidelines were disseminated in mainland China
to improve the outcomes of critically ill patients, including sepsis
patients.20 However, a study found that compliance with the
recommendations was generally poor in China, but those sepsis
patients who were treated strictly according to the 6-hour
resuscitation guidelines had significant reductions in 28-day
mortality.21 Hence, a more substantive effort is still required to
fully implement the Surviving Sepsis Campaign in mainland China