Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-17T17:22:27.571Z Has data issue: false hasContentIssue false
  • English
  • Français

Racial and Ethnic Disparities in Healthcare-Associated Infections in the United States, 2009–2011

Published online by Cambridge University Press:  10 May 2016

Anila Bakullari ,
Mark L. Metersky ,
Yun Wang ,
Noel Eldridge ,
Sheila Eckenrode ,
Michelle M. Pandolfi ,
Lisa Jaser ,
Deron Galusha  and
Ernest Moy
Anila Bakullari
Affiliation:
Qualidigm, Wethersfield, Connecticut
Mark L. Metersky
Affiliation:
Qualidigm, Wethersfield, Connecticut Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
Yun Wang
Affiliation:
Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
Noel Eldridge
Affiliation:
Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
Sheila Eckenrode
Affiliation:
Qualidigm, Wethersfield, Connecticut
Michelle M. Pandolfi
Affiliation:
Qualidigm, Wethersfield, Connecticut
Lisa Jaser
Affiliation:
Qualidigm, Wethersfield, Connecticut Griffin Hospital Pharmacy, Derby, Connecticut
Deron Galusha
Affiliation:
Qualidigm, Wethersfield, Connecticut Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Ernest Moy
Affiliation:
Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
Rights & Permissions [Opens in a new window]

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background.

Little is known about racial and ethnic disparities in the occurrence of healthcare-associated infections (HAIs) in hospitalized patients.

Objective.

To determine whether racial/ethnic disparities exist in the rate of occurrence of HAIs captured in the Medicare Patient Safety Monitoring System (MPSMS).

Methods.

Chart-abstracted MPSMS data from randomly selected all-payer hospital discharges of adult patients (18 years old or above) between January 1, 2009, and December 31, 2011, for 3 common medical conditions: acute cardiovascular disease (composed of acute myocardial infarction and heart failure), pneumonia, and major surgery for 6 HAI measures (hospital-acquired antibiotic-associated Clostridium difficile, central line-associated bloodstream infections, postoperative pneumonia, catheter-associated urinary tract infections, hospital-acquired methicillin-resistant Staphylococcus aureus, and ventilator-associated pneumonia).

Results.

The study sample included 79,019 patients who had valid racial/ethnic information divided into 6 racial/ethnic groups—white non-Hispanic (n = 62,533), black non-Hispanic (n = 9,693), Hispanic (n = 4,681), Asian (n = 1,225), Native Hawaiian/Pacific Islander (n = 94), and other (n = 793)—who were at risk for at least 1 HAI. The occurrence rate for HAIs was 1.1% for non-Hispanic white patients, 1.3% for non-Hispanic black patients, 1.5% for Hispanic patients, 1.8% for Asian patients, 1.7% for Native Hawaiian/Pacific Islander patients, and 0.70% for other patients. Compared with white patients, the age/gender/comorbidity-adjusted odds ratios of occurrence of HAIs were 1.1 (95% confidence interval [CI], 0.99-1.23), 1.3 (95% CI, 1.15-1.53), 1.4 (95% CI, 1.07-1.75), and 0.7 (95% CI, 0.40-1.12) for black, Hispanic, Asian, and a combined group of Native Hawaiian/Pacific Islander and other patients, respectively.

Conclusions.

Among patients hospitalized with acute cardiovascular disease, pneumonia, and major surgery, Asian and Hispanic patients had significantly higher rates of HAIs than white non-Hispanic patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S10 - S16
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. US Census Bureau. Newsroom. U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now. December 12, 2012. http://www.census.gov/newsroom/releases/archives/population/cbl 2-243.html. Accessed January 15, 2014.Google Scholar
2. Ennis, SR, Rios-Vargas, M, Albert, NG. 2010 Census Briefs. The Hispanic Population: 2010. May 2012. http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf. Accessed October 24, 2013.Google Scholar
3. Hoeffel, EM, Rastogi, S, Ouk Kim, M, Shahid, H. 2010 Census Briefs. The Asian Population: 2010. March 2012. http://www.census.gov/prod/cen2010/briefs/c2010br-ll.pdf. Accessed October 24, 2013.Google Scholar
4. Institute of Medicine. Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academy Press, 2002.Google Scholar
5. Thorpe, RJ, Richard, P, Bowie, IV, LaVeist, TA, Gaskin, DJ. Economic burden of men's health disparities in the United States. Int J Mens Health 2013;12:195–212.CrossRefGoogle Scholar
6. Flores, G, Ngui, E. Racial/ethnic disparities and patient safety. Pediatr Clin N A 2006;53:1197–1215.Google Scholar
7. Coffey, RM, Andrews, RM, Moy, E. Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators. Med Care 2005;43:148–157.Google Scholar
8. Romano, PS, Geppert, JJ, Davies, S, Miller, MR, Elixhauser, A, McDonald, KM. A national profile of patient safety in U.S. hospitals. Health Aff (Millwood) 2003;22:154–166.Google Scholar
9. Metersky, ML, Hunt, DR, Kliman, R, et al. Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring System. Med Care 2011;49: 504–510.CrossRefGoogle ScholarPubMed
10. Hunt, DR, Verzier, N, Abend, SL, et al. Fundamentals of Medicare Patient Safety Surveillance: Intent, Relevance, and Transparency. AHRQ's compendium of patient safety research advances in patient safety: from research to implementation. http://www .ahrq.gov/downloads/pub/advances/vol2/Hunt.pdf. Accessed December 15, 2013.Google Scholar
11. Wang, Y, Eldridge, N, Metersky, ML, et al. National trends in patient safety for four common conditions, 2005-2011. N Engl J Med 2014;370:341–351.Google Scholar
12. Stulberg, JJ, Delaney, CP, Neuhauser, DV, Aron, DC, Fu, P, Koroukian, SM. Adherence to Surgical Care Improvement Project measures and the association with postoperative infections. JAMA 2010;303:2479–2485.CrossRefGoogle ScholarPubMed
13. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN). September 24, 2013. http://www.cdc.gov/nhsn/. Accessed February 7, 2014.Google Scholar
14. Agency for Healthcare Research and Quality. AHRQuality Indicators. Patient Safety Indicators Overview. http://www.qualityindicators.ahrq.gov/Modules/psi_resources.aspx. Accessed February 14, 2014.Google Scholar
15. Freedberg, DE, Salmasian, H, Friedman, C, Ahrams, JA. Proton pump inhibitors and risk for recurrent Clostridium difficile infection among inpatients . Am J Gastroenterol 2013; 108:1794–1801.Google Scholar
16. Murphy, CR, Avery, TR, Dubberke, ER, Huang, SS. Frequent hospital readmissions for Clostridium difficile infection and the impact on estimates of hospital-associated C. difficile burden. Infect Control Hosp Epidemiol 2012;33:20–28.Google Scholar
17. Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763–1771.Google Scholar
18. Dick, A, Liu, H, Zwanziger, J, et al. Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia. BMC Health Serv Res 2012;12:432.CrossRefGoogle ScholarPubMed
19. Chenoweth, C, Saint, S. Preventing catheter-associated urinary tract infections in the intensive care unit. Crit Care Clin 2013; 29:19–32.Google Scholar
20. US Census Bureau. Educational Attainment. Educational Attainment in the United States: 2013—Detailed Tables. January 1, 2013. http://www.census.gov/hhes/socdemo/education/data/cps/2013/tables.html. Accessed January 15, 2014.Google Scholar
21. US Census Bureau. The 2012 Statistical Abstract. Income, Expenditures, Poverty, and Wealth. June 27, 2012. http://www.census.gov/compendia/statab/cats/income_expenditures _poverty_wealth.html. Accessed February 7, 2014.Google Scholar
22. Ryan, C. American Community Survey Reports. Language Use in the United States: 2011. August 2013. https://www.census.gov/prod/2013pubs/acs-22.pdf. Accessed January 15, 2014.Google Scholar
23. Lion, KC., Rafton, SA, Shafii, J, et al. Association between language, serious adverse events, and length of stay among hospitalized children. Hosp Pediatr 2013;3:219–225.Google Scholar
24. Divi, C, Koss, RK, Schmaltz, SP, Loeb, JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care 2007;19(2):60–67.Google Scholar
25. DeCamp, LR, Kuo, DZ, Flores, G, O'Connor, K., Minkovitz, CS. Changes in language services use by US pediatricians. Pediatrics 2013;132(2):e396–e406.Google Scholar