Health inequalities in incidence of bacteraemias: a national surveillance and data linkage study, England, 2018 to 2022

Abstract

BackgroundHealth inequalities exist globally, but limited data exist on this topic for bacteraemia.AimIn this study we investigated health inequalities surrounding bacteraemia in England, to identify high-risk population groups and areas of intervention.MethodsWe retrospectively analysed English surveillance data between 2018 and 2022 for Escherichia coli, Klebsiella species, Pseudomonas aeruginosa, and both meticillin-sensitive and resistant Staphylococcus aureus (MSSA, MRSA) bacteraemia. Crude incidence rates stratified by index of multiple deprivation and ethnic groups were calculated; age-adjusted rate ratios were estimated using negative binomial regression models.ResultsWe identified 342,787 bacteraemia cases. Across all pathogens, as the level of deprivation rose, so did the age-adjusted bacteraemia incidence rate ratio. Compared with residents of the 20% least deprived areas of England, residents of the 20% most deprived areas had a 2.68-fold increased bacteraemia rate for MRSA (95% CI: 2.29-3.13) and 1.95-fold for E. coli (95% CI: 1.84-2.05), and 15% higher odds of dying within 30 days of any bacteraemia (95% CI: 1.13-1.19). After age adjustment, the incidence of all bacteraemia was higher in the Asian and Black groups compared with the White group: for MRSA, 79% higher in the Asian (95% CI: 1.51-2.10) and 59% higher in the Black (95% CI: 1.29-1.95) groups. The exception was MSSA, whose incidence was highest in the White group.ConclusionDisproportionately higher age-adjusted incidence of bacteraemia occurred in deprived areas and ethnic minorities. These disparities are likely multifactorial, possibly including socioeconomic, cultural, and systemic risk factors and different burden of comorbidities. Better understanding these factors can enable targeted interventions.

Keywords: bacteraemia; ethnicity; health inequities; public health surveillance; socioeconomic factors.

Figure 1

Crude and age-standardised incidence rate of bacteraemia by index of multiple deprivation group, England, January 2018–December 2022 (n = 342,787 cases)

Figure 2

Crude and age-standardised incidence of bacteraemia by ethnic group, England, January 2018–December 2022 (n = 342,787 cases)

Figure 3

Crude and age-standardised incidence of community- and hospital-onset bacteraemia by ethnic group, England, January 2018–December 2022 (n = 342,787 cases)