Abstract
BackgroundHospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic variation across neighborhoods. While individual-level risk factors, such as age, sex, HIV infection, and diabetes have been described, the role of neighborhood-level factors (e.g., neighborhood HIV prevalence or income) has not been examined.MethodsTo explore plausible neighborhood-level factors associated with CA-MRSA-related hospitalizations, a retrospective analysis was conducted using New York City hospital discharges from 2006 and New York City-specific survey and health department surveillance data. CA-MRSA-related hospitalizations were identified using diagnosis codes and admission information. Associations were determined by using sex-specific multilevel logistic regression.ResultsThe CA-MRSA hospitalization rate varied by more than six-fold across New York City neighborhoods. Females hospitalized with CA-MRSA had more than twice the odds of residing in neighborhoods in the highest quintile of HIV prevalence (adjusted odds ratio [AOR]Q5 vs. Q1 2.3, 95% CI: 1.2, 2.7). Both males and females hospitalized with CA-MRSA had nearly twice the odds of residing in neighborhoods with moderately high proportion of men who have sex with men (MSM) residing in the neighborhood (males: AORQ4 vs. Q1 1.7, 95% CI: 1.1, 2.7; females: AORQ4 vs. Q1 2.0, 95% CI: 1.1, 3.6); but this association did not hold for neighborhoods in the highest quintile (males: AORQ5 vs. Q1 1.2, 95% CI: 0.76, 1.8; females: AORQ5 vs. Q1 1.5, 95% CI: 0.82, 2.7).ConclusionsNeighborhood-level characteristics were associated with CA-MRSA hospitalization odds, independent of individual-level risk factors, and may contribute to the population-level burden of CA-MRSA infection.
Highlights
Hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-Methicillin-resistant Staphylococcus aureus (MRSA)) infection have increased in New York City, with substantial geographic variation across neighborhoods
Plausible neighborhood-level risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) include neighborhood Human immunodeficiency virus (HIV) prevalence and the proportion of men in the neighborhood who are men who have sex with men (MSM), as rates of CA-MRSA are higher among HIV positive persons [11,12] as well as MSM [13]; neighborhood income distribution, as CA-MRSA risk factors including crowding [14] and limited access to medical care [10] may be more common among persons living in poverty; and levels of emergency department (ED) usage [15], because persons lacking health insurance may rely on the ED for medical treatment for worsening CA-MRSA infections
CA-MRSA hospitalizations had more than 3 times the odds of having an HIV diagnosis
Summary
Hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic variation across neighborhoods. While individual-level risk factors, such as age, sex, HIV infection, and diabetes have been described, the role of neighborhood-level factors (e.g., neighborhood HIV prevalence or income) has not been examined. Several individual-level factors have been found to be associated with an increased risk of CA-MRSA infection, including male sex [4,5], drug use [6], participation in contact sports [7], sharing of personal items [8,9], and homelessness [6,10]. Neighborhood-level or geographic risk factors are correlated with individual-level factors, but their role in CA-MRSA hospitalization has not been systematically examined. Understanding neighborhood-level risk factors for CA-MRSA, as has been done for a number of other health outcomes [16,17,18], is important to help to target public health surveillance and interventions for what has become an increasing public health concern
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
