Study Finds Race and Rurality Have Impacts on HAI Risk and Outcomes

A new cohort study of hospitalized patients found that “race and rurality have an impact on healthcare-associated infection (HAI) risk and outcomes.” CIDRAP has the news.

The study found that “Black urban patients have a lower risk of HAIs than do White urban patients. But Black rural patients with HAIs have a significantly higher risk of intensive care unit (ICU) admission and in-hospital death than White urban patients, even after accounting for potential confounders.” The authors of the study conclude that race and rurality are “important proxies for structural disadvantage, reflecting undermeasured or unmeasured social risk.”

The research team “examined data on patients hospitalized for 48 hours or more at one urban and two suburban hospitals from January 1, 2017, through August 31, 2020. They classified patients on the basis of the combination of two social determinants of health (SDOH): Patient race (Black or White) and rurality of the patient's home (based on Zip code).”

Recognized HAIs occurred during 6,699 of the 214,955 admissions studied. Among the 653 HAI patients admitted to the ICU, “Black rural patients had a nearly twofold increased risk of ICU admission…compared with White urban patients.” Black rural patients also had a “much higher risk of in-hospital death…than White urban patients.”

The authors suggest that the “markedly increased risk of ICU admission and death in Black rural patients could be attributed to a factor that has been documented in previous studies—that Black patients are more likely than White patients to receive non–first-line antibiotics for infections. But they also suggest that Black rural patients may be sicker in ways they could not measure.” An accompanying commentary suggests that Black rural patients are “affected by unique sets of social, structural, and systemic barriers and opportunities before and during admission to a facility that influence different pathways to developing an HAI, such as patient-practitioner relationships, quality of accessible health care facilities, neighborhood socioeconomic opportunity, transportation systems, and health system investment” that may result in inequity.