Race, rurality can increase risk for hospital infections, study finds

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Key takeaways:

• Rural patients are at an increased risk for hospital-associated infections.
• Black rural patients face the highest risks for ICU admission and in-hospital death.

BOSTON — White and Black patients in rural areas face an increased risk for hospital-associated infections, and Black rural patients experience the highest risks for ICU admission an in-hospital death, researchers reported at IDWeek.

“When we look at rural adults that are Black versus white, Black rural adults tend to have a decreased health-related quality of life, decreased health care access and increased numbers of chronic disease,” Jennie H. Kwon, DO, MSCI, associate professor of medicine at the Washington University School of Medicine in St. Louis, said during a presentation. “Taken together, it gives us a reason to believe that perhaps there’s an interaction between race and ruralities when it comes to HAIs.”

Kwon and colleagues conducted a retrospective cohort study of adults aged 18 years or older who were admitted to the university’s main academic medical center or one of its two suburban community centers for more than 48 hours between Jan. 1, 2017, and Aug. 31, 2020. Although the hospitals are not rural, Kwon said they serve many patients from both Missouri and Illinois who live in rural areas.

The researchers defined hospital-associated infections (HAIs) as positive cultures from urine, blood or respiratory specimens collected 48 hours after admission. They used a generalized estimating equations (GEE) model to determine disparity-related risk factors for an HAI — race/rurality, sex, Medicaid status, census median income quartile — and to analyze ICU admissions for HAIs and in-hospital death.

According to the study, out of nearly 215,000 hospital admissions, 3.1% of patients developed an HAI, including 3.1% of white urban patients, 3.9% of white rural patients, 2.7% of Black urban patients and 4.1% of Black rural patients.

Black rural patients with an HAI had a higher risk for ICU admission and in-hospital death compared with white rural and Black urban patients, whose outcomes were similar to white urban patients.

Kwon noted that the study cohort was relatively small compared with the rest of the nation, and that more research needs to be conducted to understand how to improve health care for these patients, especially populations that travel long distances or simply need better care.

“I think we’re just kind of scratching the surface of understanding what is going on,” Kwon said. “I imagine we’re kind of on an airplane looking down — we see shapes, we see signals [but] we don’t quite know what is going on yet. But, I think it’s important to think about.”

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