RACIAL AND ETHNIC DISPARITIES IN HEALTHCARE-ASSOCIATED INFECTIONS IN THE UNITED STATES

Abstract

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To explore the racial and ethnic differences in the occurrence of healthcare-associated infections (HAIs) captured using the most recent available National Inpatient Survey (NIS) data for 2016-2017. METHODS: Using merged NIS data from 2016-2017, for adult patients (18 and above), 9 HAI measures - surgical site infection (SSI), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), hospital-acquired pneumonia (HAP), methicillin-resistant staphylococcus aureus (MRSA) pneumonia, postoperative pneumonia (POP), MRSA sepsis and clostridium difficile infection (c. diff) were explored using ICD-10 codes. All 9 HAI measures were combined into a composite measure, hospital-associated infection (HAI), and the percent incidence was calculated. Using a binomial regression model and controlling for potentially confounding comorbidities, the odds of HAI were estimated among racial/ethnic groups. RESULTS: The study sample included 12,121,911 patients with racial/ethnic information divided into 6 groups based on AHRQ classification - White (7,868,335), Black (1,768,425), Hispanic (1,277,381), Asian/Pacific Islander (317,288), Native American (72,111), other (348,460) and 469,911 with missing values. The occurrence rate for HAI was 2.6% for White, 2.2% for Black, 1.9% for Hispanic, 1.7% for Asian/Pacific Islander, 2.9% for Native American, and 2.0% for ‘other’. Compared to White patients, the age, gender, and comorbidity adjusted odds of the occurrence of HAI were 0.94 for Black, 0.93 for Hispanic, 0.93 for Asian/Pacific Islander, and 1.19 for Native Americans. All outcomes were statistically significant with p-values <0.01. There was a statistically significant interaction between gender and race showing the most protective effect among female Asian/Pacific Islanders. CONCLUSIONS: This study highlights important racial/ethnic differences in the occurrence of HAI with Native Americans having the highest risk for infection among minority groups. Whereas another study using data from the Medicare Patient Safety Monitoring System from 2009-2011 showed a lower incidence of HAI among White patients, we found a higher incidence compared to other groups except for Native Americans. Across both studies, Native Americans were at higher risk. Further analysis suggests that these differences may be driven by the incidence of c. diff documented in the literature to be more common among white patients. CLINICAL IMPLICATIONS: This adds to the limited body of knowledge on racial/ethnic differences in HAI and highlights outcomes among Native American patients. It encourages further research into the underlying causes to inform appropriate interventions. DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Lorenzo Leys, source=Web Response No relevant relationships by Alem Mehari, source=Web Response No relevant relationships by Kelechi Weze, source=Web Response