Major article
Burden of present-on-admission infections and health care-associated infections, by race and ethnicity

https://doi.org/10.1016/j.ajic.2014.08.019Get rights and content

Highlights

  • Blacks are hospitalized with bloodstream infections more often than whites.

  • Hispanics are hospitalized with urinary tract infections more often than whites.

  • Enhanced ambulatory care can reduce racial/ethnic differences in infections.

Background

In the United States incidence of sepsis and pneumonia differ by race, but it is unclear whether this is due to intrinsic factors or health care factors.

Methods

We conducted a study of 52,006 patients hospitalized during 2006-2008 at a referral hospital in upper Manhattan. We examined how the prevalence of present-on-admission and health care-associated infection compared between non-Hispanic blacks, Hispanics, and non-Hispanic whites adjusting for sociodemographic factors, admission through the emergency department, and comorbid conditions.

Results

Non-Hispanic blacks had 1.59-fold (95% confidence interval [CI], 1.29-1.96) and 1.55-fold (95% CI, 1.35-1.77) risk of community-acquired bloodstream infection and urinary tract infection compared with non-Hispanic whites. Hispanic patients had 1.31-fold (95% CI, 1.15-1.49) risk of presenting with community-acquired urinary tract infection compared with non-Hispanic whites. Controlling for admission through the emergency department, comorbidity, and neighborhood income attenuated the differences in prevalence of infections.

Conclusions

We found that health disparities in present-on-admission infections might be largely explained by potential lack of ambulatory care, socioeconomic factors, and comorbidity.

Section snippets

Study setting and patient population

We conducted a retrospective study of patients who were discharged from January 2006-December 2008 from a tertiary referral hospital in upper Manhattan. We extracted data from the Clinical Data Warehouse that integrates information from more than 20 clinical electronic sources; the admission, discharge, and transfer system; and the computerized physician and nursing order entry system. Detailed description of the methods for integration of data have previously been published.9

Case definition

We examined racial

Study population

There were 60,994 patients seen in the adult tertiary care hospital January 2006-December of 2008. After excluding 748 patients lacking neighborhood household income data and 8,345 patients who had transferred from other medical facilities or were previously hospitalized within 7 days, the final analytic sample was 52,006 patients. Of these, non-Hispanic whites, non-Hispanic blacks, Hispanics, other races, and those with unspecified race comprised 42%, 18%, 25%, 5.9%, and 9.4% of the study

Discussion

In this population of more than 50,000 inpatients, we found that non-Hispanic blacks were at slightly elevated risk of developing BSI throughout the hospital stay compared with non-Hispanic whites. Could this have been influenced by differential treatment of blacks in the hospitals? The data indicate that although non-Hispanic blacks were less likely to receive indwelling devices, this had no bearing on the difference in incidence of infections. This association was partially reduced by

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    To assure the integrity of our review process, the blinded peer review and final decision regarding publication for any manuscript on which the AJIC editor or an associate editor is an author is handled independently; that editor/associate editor has no decision making role in such manuscripts.

    Conflicts of interest: None to report.

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