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. 2022 Nov;14(11):474-486.
doi: 10.14740/jocmr4828. Epub 2022 Nov 29.

Trends and Disparities in Outcomes of Clostridioides difficile Infection Hospitalizations in the United States: A Ten-Year Joinpoint Trend Analysis

Pius Ehiremen Ojemolon  1 , Hafeez Shaka  2 , Robert Kwei-Nsoro  1 , Hisham Laswi  1 , Ebehiwele Ebhohon  3 , Abdultawab Shaka  4 , Abdul-Rahman Abusalim  1 , Benjamin Mba  1   5
Affiliations

Trends and Disparities in Outcomes of Clostridioides difficile Infection Hospitalizations in the United States: A Ten-Year Joinpoint Trend Analysis

Pius Ehiremen Ojemolon et al. J Clin Med Res. 2022 Nov.

Abstract

Background: Clostridioides difficile infection (CDI) is the most frequently reported nosocomial infection. This study aimed to describe epidemiological trends, sex, race, and economic disparities in clinical and mortality outcomes among CDI hospitalizations over a decade.

Methods: We queried Nationwide Inpatient Sample databases from 2010 to 2019, identified hospitalizations with CDI, and obtained the incidence and admission rate of CDI per 100,000 adult hospitalizations each year. We analyzed trends in mortality rate, mean length of hospital stay (LOS), and mean total hospital charge (THC). We highlighted disparities in outcomes stratified by sex, race, and mean household income quartile.

Results: Of the 305 million hospitalizations included in our study, over 3.3 million were complicated by CDI, with 1.01 million principal admissions for CDI. Among primary admissions for CDI, the mortality rate decreased from 3.2% in 2010 to 1.4% in 2019. Mean LOS reduced from 6.6 to 5.3 days while mean THC increased from US$40,593 to US$42,934 between 2010 and 2019. Females had a 21% decrease in adjusted odds of mortality compared to males (all P-trends < 0.001). Middle-aged and elderly patients had aOR of 4.96 and 14.74 respectively for mortality when compared to young adults (P < 0.001). Mortality rates showed a steady decline among Whites over the study period. Mean LOS trends were similar across racial subgroups.

Conclusions: Outcomes of CDI hospitalizations improved over the studied decade. Older age, male sex, and being from a minority racial group were associated with worse clinical and mortality outcomes. Further studies are needed to elucidate the reasons for these findings.

Keywords: Clostridioides difficile infection; Disparities; Hospitalization; Mortality; Trends.

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Conflict of interest statement

The authors have no current or potential conflict to declare.

Figures

Figure 1
Figure 1
Trend in the adjusted incidence of CDI among all hospitalizations from 2010 to 2019. *Statistically significant. APC: annual percentage change; CDI: Clostridioides difficile infection.
Figure 2
Figure 2
Trend in the mortality rate for hospitalizations with CDI (sex subgroup analysis). CDI: Clostridioides difficile infection.
Figure 3
Figure 3
Trend in the mortality rate for hospitalizations with CDI (racial subgroup analysis). CDI: Clostridioides difficile infection.
Figure 4
Figure 4
Trends in adjusted CDI admission rate from 2010 to 2019. *Statistically significant. APC: annual percentage change; CDI: Clostridioides difficile infection.
Figure 5
Figure 5
Trend in mortality rate hospitalizations with a principal admitting diagnosis of CDI (sex subgroup analysis). CDI: Clostridioides difficile infection.
Figure 6
Figure 6
Trend in mortality rate hospitalizations with a principal admitting diagnosis of CDI (racial subgroup analysis). CDI: Clostridioides difficile infection.
See this image and copyright information in PMC

References

    1. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R. et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198–1208. doi: 10.1056/NEJMoa1306801. - DOI - PMC - PubMed
    1. Riddle DJD, Dubberke ERD. Trends in Clostridium difficile disease: epidemiology and intervention. Infect Med. 2009;26(7):211–220. - PMC - PubMed
    1. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, Farley MM. et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825–834. doi: 10.1056/NEJMoa1408913. - DOI - PMC - PubMed
    1. Zhang S, Palazuelos-Munoz S, Balsells EM, Nair H, Chit A, Kyaw MH. Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study. BMC Infect Dis. 2016;16(1):447. doi: 10.1186/s12879-016-1786-6. - DOI - PMC - PubMed
    1. Guh AY, Mu Y, Winston LG, Johnston H, Olson D, Farley MM, Wilson LE. et al. Trends in U.S. Burden of Clostridioides difficile infection and outcomes. N Engl J Med. 2020;382(14):1320–1330. doi: 10.1056/NEJMoa1910215. - DOI - PMC - PubMed

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