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

OBJECTIVE: 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. DESIGN: Systematic Review and Meta-Analysis. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Duke Scholars

Author Carl F. Pieper Biostatistics & Bioinformatics, Division of Biostatistics

Author Deverick John Anderson Medicine, Infectious Diseases

Author Nwora Lance Okeke Medicine, Infectious Diseases

Author Helen Linhong Zhang Medicine, Hospital Medicine

Author Michael Yarrington Medicine, Infectious Diseases

Author Rebecca North  

Author Sonali Advani Medicine, Infectious Diseases

Author Steph Hendren  

Author Reinaldo Perez Medicine, Infectious Diseases

Author Erin Brooke Gettler Medicine, Infectious Diseases