Socioeconomic factors explain racial disparities in invasive community-associated methicillin-resistant Staphylococcus aureus disease rates

See, Isaac; Wesson, Paul; Gualandi, Nicole; Dumyati, Ghinwa; Harrison, Lee H.; Lesher, Lindsey; Nadle, Joelle; Petit, Susan; Reisenauer, Claire; Schaffner, William; Tunali, Amy; Mu, Yi; Ahern, Jennifer

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Socioeconomic factors explain racial disparities in invasive community-associated methicillin-resistant Staphylococcus aureus disease rates

Published Date:

Mar 01 2017

Source:

Clin Infect Dis. 64(5):597-604.

[PDF-173.96 KB]

Details:

Personal Authors:

See, Isaac ; Wesson, Paul ; Gualandi, Nicole ; Dumyati, Ghinwa ; Harrison, Lee H. ; ... More ▼

Keywords:

[+]

Pubmed ID:

28362911

Pubmed Central ID:

PMC5656382

Description:

Introduction

Invasive community-associated methicillin-resistant Staphylococcus aureus (MRSA) incidence in the United States is higher among black persons than white persons. We explored the extent to which socioeconomic factors might explain this racial disparity.

Methods

A retrospective cohort was based on CDC’s Emerging Infections Program surveillance data for invasive community-associated MRSA cases (isolated from a normally sterile site of an outpatient or on hospital admission day ≤3 in a patient without specified major healthcare exposures) from 2009–2011 in 33 counties of 9 states. We used generalized estimating equations to determine census tract-level factors associated with differences in MRSA incidence and inverse odds ratio weighted mediation analysis to determine the proportion of racial disparity mediated by socioeconomic factors.

Results

Annual invasive community-associated MRSA incidence was 4.59/100,000 among whites and 7.60/100,000 among blacks (rate ratio: 1.66, 95% CI, 1.52–1.80). In the mediation analysis, after accounting for census tract-level measures of federally-designated medically underserved areas, education, income, housing value, and rural status, 91% of the original racial disparity was explained; no significant association of black race with community-associated MRSA remained (rate ratio: 1.05, 95% CI, 0.92–1.20).

Conclusions

The racial disparity in invasive community-associated MRSA rates was almost entirely mediated by socioeconomic factors. The specific factors that underlie the association between tract-level socioeconomic measures and MRSA incidence, which may include modifiable social (e.g., poverty, crowding) and biological factors (not explored in this analysis), should be elucidated to define strategies for reducing racial disparities in community-associated MRSA rates.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

U50 CK000197/CK/NCEZID CDC HHS/United States
T32 MH019105/MH/NIMH NIH HHS/United States
U50 CK000198/CK/NCEZID CDC HHS/United States
U50 CK000199/CK/NCEZID CDC HHS/United States
U50 CK000196/CK/NCEZID CDC HHS/United States
U50 CK000201/CK/NCEZID CDC HHS/United States
U50 CK000195/CK/NCEZID CDC HHS/United States
CC999999/Intramural CDC HHS/United States
U50 CK000204/CK/NCEZID CDC HHS/United States
U50 CK000194/CK/NCEZID CDC HHS/United States
U50 CK000203/CK/NCEZID CDC HHS/United States

Main Document Checksum:

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Supporting Files:

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	nihms913895.nxml	text/xml
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