Racial disparities in healthcare-associated infections: a systematic review and meta-analysis

Racial and ethnic disparities in healthcare-associated infections (HAIs) could have significant implications for hospital-based incentive programs. We sought to quantify racial and ethnic disparities in HAIs across inpatients in the United States.

Systematic Review and Meta-Analysis.

Medline, Embase, and Scopus were searched 2008-2022 for English language studies describing reportable HAIs among inpatients and references to race or ethnicity. Studies were excluded if they used an aggregate outcome of "infection," described a non-acute care setting, or measured a respiratory virus. Meta-analysis was performed using random-effects model on pooled continuous outcomes with 3 or more studies.

39 studies met criteria for inclusion; 23 evaluated surgical site infections (SSI), 6 evaluated hospital-onset Clostridioides difficile infection (HO-CDI), 5 evaluated central line-associated bloodstream infections (CLABSI), and 8 examined other HAIs. There was a high degree of heterogeneity across studies. Meta-analysis was performed for 10 distinct HAI/risk factor combinations. Race and ethnicity were not associated with SSIs (Black vs White OR 1.19, 95% CI 0.95-1.48; Hispanic vs White OR 1.01, 95% CI 0.78-1.31). Hispanic patients had lower risk of HO-CDI relative to White patients (OR 0.80, 95% CI 0.64-0.98). Black (OR 1.36, 95% CI 1.07-1.70) or Hispanic (OR 1.16, 95% CI 1.073-1.249) patients had increased risk of CLABSI compared with White patients.

Racial and ethnic disparities were observed in rates of HAIs, specifically for CLABSI and HO-CDI. However, conclusions are limited by the substantial heterogeneity present. Further research characterizing social determinants of health driving these disparities is needed.