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BMC Infect Dis. 2016 Aug 27;16(1):454. doi: 10.1186/s12879-016-1788-4.

Clostridium difficile infection health disparities by race among hospitalized adults in the United States, 2001 to 2010.

Author information

1
The University of Texas College of Pharmacy, 2409 University Avenue, A1900, Austin, TX, 78712, USA.
2
The University of Texas Health Science Center Pharmacotherapy and Education Research Center, 7703 Floyd Curl Drive, MC-6220, San Antonio, TX, 78229, USA.
3
The University of Texas College of Pharmacy, 2409 University Avenue, A1900, Austin, TX, 78712, USA. kdaniels46@utexas.edu.
4
The University of Texas Health Science Center Pharmacotherapy and Education Research Center, 7703 Floyd Curl Drive, MC-6220, San Antonio, TX, 78229, USA. kdaniels46@utexas.edu.

Abstract

BACKGROUND:

Recognition of health disparities in Clostridium difficile infection (CDI) is an initial step toward improved resource utilization and patient health. The purpose of this study was to identify health disparities by black vs. white race among hospitalized adults with CDI in the United States (U.S.) over 10 years.

METHODS:

This was a retrospective analysis of the U.S. National Hospital Discharge Surveys from 2001 to 2010. Eligible cases included adults with an ICD-9-CM code for CDI (008.45). Patients with missing race or "other race" were excluded. The primary outcome, CDI incidence, was calculated as CDI discharges per 1,000 total discharges. Data weights were used to determine national estimates. Secondary outcomes included in-hospital mortality, hospital length of stay (LOS), and severe CDI. Comparisons were made using bivariable analyses. Race was assessed as an independent risk factor for CDI outcomes using logistic regression or proportional hazards models.

RESULTS:

These data represent 1.7 million CDI discharges, where 90 % of patients were identified as white and 10 % black. Blacks differed from whites with respect to all baseline characteristics (p <0.0001). CDI incidence was significantly higher in whites compared to blacks (7.7/1,000 discharges vs. 4.9/1,000 discharges, p < 0.0001). Blacks had higher mortality (7.4 % vs. 7.2 %, p < 0.0001), LOS >7 days (57 % vs. 52 %, p < 0.0001), and severe CDI (24 % vs. 19 %, p < 0.0001). In multivariable analyses, black race was a positive predictor of mortality (OR 1.12, 95 % CI 1.09-1.15) and severe CDI (OR 1.09, 95 % CI 1.07-1.11), and negative predictor for hospital LOS (OR 0.93, 95 % CI 0.93-0.94).

CONCLUSIONS:

CDI incidence was higher for white patients; however, black race was independently associated with mortality and severe CDI.

KEYWORDS:

Clostridium difficile; Disparity; Race

PMID:
27568176
PMCID:
PMC5002147
DOI:
10.1186/s12879-016-1788-4
[Indexed for MEDLINE]
Free PMC Article

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