Health care-associated infections (HAIs) cause significant morbidity and mortality, but little is known about structural factors affecting race and rurality.
Katelin B. Nickel, MPH, Sr. Programmer Analyst, WashU Medicine Division of Infectious Diseases along with Hannah Kinzer, MPH; Anne M. Butler, PhD, MS; Karen E. Joynt Maddox, MD, MPH; Victoria J. Fraser, MD, Adolphus Busch Professor of Medicine and Chair of the Department of Medicine; Jason P. Burnham, MD, MSCI; and Jennie H. Kwon, DO, MSCI, were recently published in JAMA NO along with an invited commentary. The multi-authored paper is titled, “Intersection of Race and Rurality With Health Care–Associated Infections and Subsequent Outcomes”.
Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality. The goal of the study was evaluating the association of race and rurality—proxies for structural disadvantage—on HAI and subsequent outcomes such as intensive care unit (ICU) admission and death. Using hospitalization data from the BJC hospital system on nearly 215,000 admissions, we found that 3% of admissions were complicated by an HAI, 20% of admissions with an HAI resulted in an ICU admission, and 17% of HAI admissions resulted in death during the hospitalization.
Compared to White urban patients, Black urban patients had a decreased risk of HAI while White rural patients had an increased risk of HAI. However, among HAI admissions, Black rural patients were nearly twice as likely to be admitted to the ICU admission or die compared to White urban patients, even after accounting for potential differences between populations. This suggests that structural factors and disinvestment in specific communities may impact patient outcomes including HAI and subsequent outcomes.
We identified factors related to race and rurality in HAIs and adverse outcomes from HAIs, likely reflecting the greater burden of structural and systemic barriers to health faced by specific patient populations. Our results also highlight the importance of considering the intersection of structural risk factors, e.g. race and rurality. By identifying populations vulnerable to HAIs and negative outcomes, we lay the groundwork for additional health equity studies to further investigate the relationships underpinning these inequities and develop comprehensive solutions to improve healthcare.
Published: February 3, 2025. doi:10.1001/jamanetworkopen.2024.53993