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Published on: July 13, 2019
Racial and ethnic disparities in central line-associated bloodstream infections (CLABSI) in hospitalized patients: a
Sandeep Tripathi1,2, Taylor Walter3, Jeremy McGarvey3
1Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Illinois at OSF HealthCare, Peoria, IL, USA.
Insights
Hispanic patients face higher central line-associated bloodstream infection (CLABSI) rates, even after accounting for risk factors. These persistent disparities highlight ongoing inequities in hospital-associated conditions.
Area of Science:
- Healthcare epidemiology
- Infectious disease research
- Health equity studies
Background:
- Central line-associated bloodstream infections (CLABSI) are significant hospital-acquired infections.
- Understanding racial and ethnic disparities in CLABSI rates is crucial for targeted interventions.
Purpose of the Study:
- To compare central line-associated bloodstream infection (CLABSI) rates across different racial and ethnic groups.
- To assess exposure-adjusted CLABSI risks, controlling for patient-level factors.
Main Methods:
- Retrospective cohort study involving 15 network hospitals.
- Analysis of 27,674 central lines from 23,133 patients (01/2018-06/2023).
- Generalized Poisson regression adjusted for demographics, insurance, language, ICU admission, comorbidities, and line usage.
Main Results:
- Overall CLABSI rate was 1.070 per 1000 central line days.
- Hispanic patients exhibited significantly higher CLABSI rates compared to non-Hispanic White patients (IRR 1.89, P=.013).
- No significant difference in CLABSI rates was found between non-Hispanic White and non-Hispanic Black patients.
Conclusions:
- Healthcare disparities in hospital-associated conditions persist, even after adjusting for known risk factors.
- Hispanic patients are at the highest risk for CLABSI in this network.
- Further research is needed to address the root causes of these persistent disparities.
Objective:
To compare the risk and exposure-adjusted central line-associated bloodstream infection (CLABSI) rates between racial and ethnic groups.
Design:
Retrospective cohort study.
Setting:
15 network hospitals in Illinois and Michigan (Part of OSF HealthCare).
Patients:
Patients of all age groups who had a central line inserted and removed during the same hospitalization between 01/2018 and 06/2023.
Methods:
CLABSI rates/1000 Central line days of the four major racial and ethnic categories (Hispanic, non-Hispanic White [NHW], non-Hispanic Black [NHB], and non-Hispanic others) were analyzed by generalized Poisson regression. Confounding variables included in the regression model based on a directed acyclic graph and included age group, insurance class, language, ICU admission, diagnostic cohorts (obesity, diabetes, dialysis, cancer, neutropenia), and line usage (blood products, chemotherapy, total parenteral nutrition).
Results:
27,674 central lines (244,889 catheter days) on 23,133 unique patients (median age 64 years, 8% pediatric patients) were included in the analysis. Overall, the CLABSI rate was 1.070/1000 Central line days. 76% of the study population was NHW, 17% NHB, and 4% Hispanic. After adjusting for confounding variables, Hispanic patients had higher CLABSI rates than NHW (IRR 1.89, 95% CI 1.15-3.10, P = .013). No significant difference was observed in the CLABSI rates between NHW and NHB patients.
Conclusion:
Disparities in hospital-associated conditions persist even after controlling for patient-level risk factors and exposures, with Hispanic patients at the highest risk.
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