Health Disparities in Central Line-Associated Bloodstream Infections: Analysis of the U.S. National Inpatient Sample...

Area of Science:

• Healthcare Disparities
• Infectious Disease Epidemiology
• Health Services Research

Background:

• Central line-associated bloodstream infections (CLABSIs) are significant causes of patient morbidity and mortality.
• Existing research has understudied health disparities in CLABSI incidence and outcomes.
• Understanding these disparities is crucial for improving patient care and resource allocation.

Purpose of the Study:

• To evaluate racial and socioeconomic disparities in CLABSI incidence.
• To assess the impact of these disparities on in-hospital mortality, length of stay (LOS), and healthcare costs.
• To identify high-risk populations for CLABSI to inform targeted interventions.

Main Methods:

• Retrospective analysis of adult hospitalizations using the National Inpatient Sample (NIS) database (2016-2022).
• Identification of CLABSI using AHRQ's Patient Safety Indicator 07 for patients with central venous catheter placement.
• Analysis of outcomes including CLABSI incidence, in-hospital mortality, LOS, and costs using logistic and lognormal regression models, controlling for demographic and clinical factors.

Main Results:

• Among 6.56 million eligible central venous catheterizations, 0.25% resulted in CLABSI.
• Black patients exhibited 29.8% higher adjusted odds of CLABSI compared to White patients (p < 0.001).
• Medicaid beneficiaries had 18.4% higher odds of CLABSI than privately insured individuals (p = 0.002).
• CLABSI significantly increased LOS by 97% and hospital costs by 82% (both p < 0.001).
• In-hospital mortality was 13.3% and did not significantly differ based on CLABSI status after adjustment.

Conclusions:

• Persistent racial and socioeconomic disparities in CLABSI incidence and healthcare resource utilization were observed.
• Black individuals and Medicaid beneficiaries face the highest risk for CLABSI.
• While CLABSI rates decreased to pre-pandemic levels in 2022, associated costs and LOS remain elevated, necessitating targeted prevention strategies to address health disparities.