A recent investigation into healthcare-associated infection (HAI) testing across three hospitals within the Duke University Health System underscores the continuing challenge of health equity. This study expressly examines the infection rates within hospitals, and highlights findings that reveal racial disparities in testing instances – an issue requiring urgent attention.
Specifically, the researchers scrutinized incidences related to Clostridioides difficile infection (CDI), a prevalent disease in the healthcare environment, which impacts almost half a million individuals in the U.S. annually. The study identified a higher frequency of CDI testing among White patients as opposed to Black or non-White, non-Black (NWNB) patients, pointing to a clear imbalance in testing based on race. This disparity persists despite the similar rates of test positivity across racial groups. With these findings, the study draws attention to the importance of addressing the inequality inherent in testing rates, as this can hold significant implications for the identification and management of CDI cases.
The research was spearheaded by Bobby Warren, MPS, lab director of the Disinfection, Resistance and Transmission Epidemiology (DiRTE) Lab at Duke Antimicrobial Stewardship Outreach Network. Notably, it built upon previous studies, leveraging electronic health records to assess racial disparities in CDI testing rates and adjusted for differences in the length of patient hospital stays. Contrary to earlier studies, this research used robust and reliable methods, avoiding error-ridden hospital discharge surveys.
Over a span of seven years, from January 2015 to December 2021, the study analyzed inpatient encounters for CDI testing and proportions of positive tests by race, hospital, and year in three different hospitals, varying in size and affiliation. Their exhaustive analysis included 35,160 CDI tests and 2,571,850 patient days across all hospitals in the study.
The conclusion reaffirms and sheds light on the gaps in testing – White patients received more CDI tests and exhibited a slightly higher positivity rate as compared to Black and NWNB patients. Identifying such disparities in healthcare, the study reiterates the urgent need for further research to understand the roots of this imbalance, evaluate geography-dependent variations and ascertain whether differential access or selection for testing could be contributing factors.