Clostridium difficile Disparities by Race: Black Patients Face Higher Risk of Severe Infection

White patients are more likely to get clostridium difficile infections (CDI) in the hospital, but black people are more likely to die from CDI, according to the results of a recent retrospective analysis. The analysis, published in BMC Infectious Diseases, was conducted by Jacqueline Argamany, PharmD, of the University of Texas College of Pharmacy, and colleagues.

The researchers describe their aim saying, “The goal of this study was to identify health disparities by black vs. white race in CDI incidence and health outcomes among hospitalized adults with CDI in the U.S. over a 10-year period.”

In order to explore the question of race and its association with CDI outcomes, the researchers used data from the Centers for Disease Control and Prevention’s National Hospital Discharge Survey (NHDS). “Overall, these data represent approximately 1.7 million CDI discharges from U.S. hospitals over the study period,” say the researchers, adding, “Of these patients, 90% were white and 10% were black.”

They found that there were 7.3 cases of CDI per 1,000 discharges, and say, “CDI incidence was significantly higher for white patients (7.7 CDI discharges per 1,000 white discharges) as compared to black patients (4.9 CDI discharges per 1,000 black discharges).” However, “Black race was an independent risk factor for all health outcomes,” say the researchers. Black patients were at greater risk for both more severe CDI and mortality.

The researchers note, “The reason for such disparities in incidence and outcomes in CDI is likely multifactorial,” and go on to offer as an example demographic differences. Black patients tended to be younger than white patients, and black patients more often relied on publicly funded payment sources, such as Medicare.

This study does have limitations, including a reliance on administrative data, the self-reporting of race, and the exclusion of federal hospitals and long-term care facilities. Additionally, “data regarding patient ethnicity, socioeconomic status, treatment(s), prior medication(s), care access, and other patient demographics were unavailable for this study,” say the authors.

The authors suggest that further studies should be conducted in order to understand the disparities between blacks and whites regarding CDI. They conclude with, “Despite the higher incidence of CDI among white patients, black patients had significantly higher mortality and risk for severe CDI compared to white patients.”

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