A study recently published in Preventive Medicine Reports has cast a spotlight on the association between socioeconomic conditions and the rates of Clostridioides difficile infection (CDI). This ecological study underscores the impact of social determinants on disparities in infection rates.
While CDI prevention efforts have traditionally focused on healthcare-related factors such as antimicrobial stewardship and infection control, the report suggests that health disparities at the community level and the social conditions affecting health need to be addressed as well.
Approximately half a million CDI cases are reported by the CDC each year in the US. The risk factors include older age, recent hospitalization, poor immune system and exposure to the bacterium. Approximately two-thirds of CDI cases are tied to hospitals, long-term care facilities, and other healthcare settings, although community-acquired cases are also increasing. For this study, data from 2,532,982 individuals residing in the Denver metro area was collected and analyzed.
During the data collection period, 16,781 CDI cases were reported in the area. Geocoding was used to link these cases to the census tract of residence. The estimated crude CDI rate from 2016-2019 stood at 155 cases per 100,000 persons. From the analysis, neighborhood socioeconomic status, especially levels of social vulnerability, racial composition, and poverty were found to significantly influence rates of CDI. For example, a tenth of a unit increase in the social vulnerability index corresponded with a 5% rise in CDI rates.
The researchers concluded that the social vulnerability index could be a valuable single variable to identify neighborhoods at a greater risk of CDI. The findings also illuminate the importance of socioeconomic factors unrelated to healthcare as predictors for this healthcare-associated infection.