396. Incidence and Attributable Mortality of Clostridioides difficile Infection Among US Adults 18-64 Years of Age

Abstract

Abstract Background Studies characterizing the burden of Clostridioides difficile infection (CDI) have largely focused on older adults, with limited data among those < 65 years of age insured under commercial plans. Methods This retrospective cohort study from 2012–2020 used Optum’s de-identified Clinformatics® Data Mart of about 42 million commercially insured persons. CDI was defined by ICD9/ICD10 diagnosis codes or a combination of CDI diagnosis/testing with antibiotic receipt; cases occurring ≤60 days after prior CDI occurrences were excluded. Annual CDI incidence was evaluated among individuals who were 18–64 years old and enrolled in an Optum commercial plan by January 1 of the corresponding year. Mortality was evaluated in persons with CDI from 2016–2018 who were continuously enrolled in the database for ≥12 months prior; follow-up occurred through the earliest of 12 months, disenrollment, or death. To assess CDI-attributable mortality, CDI+ cases were matched 1:1 to CDI– controls by the propensity score for CDI. Mortality was stratified by age group, acquisition type, and hospitalization status. Results CDI incidence was generally stable from 2012–2016 (217–220 and 112–118 episodes per 100,000 person-years (PY) in the 50–64- and 18–49-year age groups, respectively) before decreasing gradually between 2016 and 2020 to 139 episodes per 100,000 PY (50–64-year age group) and to 66 episodes per 100,000 PY (18–49-year age group) (Figure 1). In the 50–64-year age group, CDI-attributable mortality increased to 2.2% at 12 months (CDI+, 4.2%; CDI−, 2.0%), with larger attributable differences observed among hospitalized (healthcare associated [HA], 18.1%; community associated [CA], 7.0%) vs nonhospitalized (HA, 3.3%; CA, −0.1%) patients (Figure 2). The CDI-attributable mortality rate of 0.6% at 12 months among the 18–49-year age group was lower than that in the 50–64-year age group but trended similarly (CDI+, 1.2%; CDI−, 0.6%). Conclusion As reported previously, both CDI incidence and attributable mortality among US individuals 18–64 years increased with age. Identifying high-risk groups among non-elderly adults is warranted to develop better strategies for effective prevention. Funded by Pfizer Inc. Disclosures Holly Yu, MSPH, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Tamuno Alfred, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Jingying Zhou, MA, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Jennifer Judy, MS, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Margaret A A. Olsen, PhD, MPH, Pfizer Inc: Advisor/Consultant|Pfizer Inc: Grant/Research Support.