Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in the United States and has been termed by the Centers for Disease Control and Prevention as an “urgent threat” in antimicrobial resistance. Traditionally a major healthcare-associated infection, CDIs have become increasingly common in community settings as well. As usage of healthcare services and certain medications are common risk factors for CDI, an individual’s access to such services can impact the CDI burden they experience. Identifying and addressing such disparities is crucial for an equitable healthcare system, but there is a general dearth of literature reviewing sociodemographic disparities in different CDI settings. This comprehensive review assesses existing evidence of racial and socioeconomic disparities across both healthcare and community settings. A search of two databases, PubMed and Scopus, yielded 15 studies assessing racial and socioeconomic disparities across different U.S. patient populations. With racial disparities, the review not only strengthens existing evidence of the burden of White patients in the incidence of healthcare-associated CDI (HA-CDI), but also identifies new evidence of this burden in community-associated CDI (CA-CDI) and some evidence of Blacks facing harsher downstream consequences of HA-CDIs like mortality and severity. With socioeconomic disparities, census tracts of lower socioeconomic strata had the highest CA-CDI burden, whereas at the individual level, results were mixed for both HA- and CA-CDI. Many of these observed disparities arise likely due to underlying differences in access to healthcare services, medications like antibiotics and proton pump inhibitors, and high-sensitivity testing methods. This study also identifies major literature gaps and potential hypotheses for future research.
Kyada, Rutvin; Leader, DrPH, MPH, Amy; and Frasso, PhD, CPH, Rosemary, "Racial and Socioeconomic Disparities in Healthcare- and Community-Associated Clostridium difficile Infection: A Rapid Review" (2020). Master of Public Health Capstone Presentations. Presentation 341.