Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system
Abstract Objective: Examine the relationship between patients’ race and prescriber antibiotic choice while accounting for differences in underlying illness and infection severity. Design: Retrospective cohort analysis. Setting: Acute care facilities within an academic healthcare system. Pati...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2024-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X24004728/type/journal_article |
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| author | David Evans Kingsley Fortin-Leung Vishnu Ravi Kumar Yanru Ma Radhika Prakash Asrani Zanthia Wiley Scott K. Fridkin CDC Prevention Epicenters Program |
| author_facet | David Evans Kingsley Fortin-Leung Vishnu Ravi Kumar Yanru Ma Radhika Prakash Asrani Zanthia Wiley Scott K. Fridkin CDC Prevention Epicenters Program |
| author_sort | David Evans |
| collection | DOAJ |
| description |
Abstract
Objective:
Examine the relationship between patients’ race and prescriber antibiotic choice while accounting for differences in underlying illness and infection severity.
Design:
Retrospective cohort analysis.
Setting:
Acute care facilities within an academic healthcare system.
Patients:
Adult inpatients from January 2019 through June 2022 discharged from the Hospital Medicine Service with an ICD-10 Code for Pneumonia.
Methods:
We describe variability in days of therapy of antimicrobials with activity against Pseudomonas aeruginosa (anti-Pseudomonas agents) or against MRSA (anti-MRSA agents), by patient’s race and ethnicity. We estimated the likelihood of receipt of any anti-Pseudomonas agents by race and modeled the effect of race on rate of use, adjusting for age, severity, and indication.
Results:
5,820 patients with 6,700 encounters were included. After adjusting for broad indication, severity, underlying illness, and age, use of anti-Pseudomonas agents were less likely among non-Hispanic Black patients than other race groups, although this effect was limited to younger patients (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.29, 0.70), and not older ones (aOR 0.98; 95% CI 0.85, 1.13); use of anti-MRSA agents were similar between groups. Among patients receiving any anti-Pseudomonas agents, Black patients received them for relatively lower proportion of their inpatient stay (incidence rate ratio 0.91; 95% CI 0.87, 0.96).
Conclusions:
We found difference in use of anti-Pseudomonas agents between non-Hispanic Black patients and other patients that could not be easily explained by indications or underlying illness, suggesting unmeasured factors may be playing a role in treatment decisions.
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| format | Article |
| id | doaj-art-9a95b5012edd42cc87cb6bb8a7e35e85 |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-9a95b5012edd42cc87cb6bb8a7e35e852024-12-20T12:05:39ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2024-01-01410.1017/ash.2024.472Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health systemDavid Evans0Kingsley Fortin-Leung1Vishnu Ravi Kumar2Yanru Ma3https://orcid.org/0000-0002-6223-4449Radhika Prakash Asrani4https://orcid.org/0000-0002-3848-6099Zanthia Wiley5Scott K. Fridkin6https://orcid.org/0000-0003-4892-693XCDC Prevention Epicenters ProgramDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USAPerelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USADivision of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USADepartment of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, USADivision of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USADivision of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USADivision of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA Abstract Objective: Examine the relationship between patients’ race and prescriber antibiotic choice while accounting for differences in underlying illness and infection severity. Design: Retrospective cohort analysis. Setting: Acute care facilities within an academic healthcare system. Patients: Adult inpatients from January 2019 through June 2022 discharged from the Hospital Medicine Service with an ICD-10 Code for Pneumonia. Methods: We describe variability in days of therapy of antimicrobials with activity against Pseudomonas aeruginosa (anti-Pseudomonas agents) or against MRSA (anti-MRSA agents), by patient’s race and ethnicity. We estimated the likelihood of receipt of any anti-Pseudomonas agents by race and modeled the effect of race on rate of use, adjusting for age, severity, and indication. Results: 5,820 patients with 6,700 encounters were included. After adjusting for broad indication, severity, underlying illness, and age, use of anti-Pseudomonas agents were less likely among non-Hispanic Black patients than other race groups, although this effect was limited to younger patients (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.29, 0.70), and not older ones (aOR 0.98; 95% CI 0.85, 1.13); use of anti-MRSA agents were similar between groups. Among patients receiving any anti-Pseudomonas agents, Black patients received them for relatively lower proportion of their inpatient stay (incidence rate ratio 0.91; 95% CI 0.87, 0.96). Conclusions: We found difference in use of anti-Pseudomonas agents between non-Hispanic Black patients and other patients that could not be easily explained by indications or underlying illness, suggesting unmeasured factors may be playing a role in treatment decisions. https://www.cambridge.org/core/product/identifier/S2732494X24004728/type/journal_article |
| spellingShingle | David Evans Kingsley Fortin-Leung Vishnu Ravi Kumar Yanru Ma Radhika Prakash Asrani Zanthia Wiley Scott K. Fridkin CDC Prevention Epicenters Program Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system |
| title_full | Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system |
| title_fullStr | Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system |
| title_full_unstemmed | Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system |
| title_short | Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system |
| title_sort | evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system |
| url | https://www.cambridge.org/core/product/identifier/S2732494X24004728/type/journal_article |
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