Isaac See1, Paul Wesson2, Nicole Gualandi1, Ghinwa Dumyati3, Lee H Harrison4, Lindsey Lesher5, Joelle Nadle6, Susan Petit7, Claire Reisenauer8, William Schaffner9, Amy Tunali10, Yi Mu1, Jennifer Ahern2. 1. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 2. Division of Epidemiology, School of Public Health, University of California, Berkeley, USA. 3. University of Rochester Medical Center, Rochester, New York, USA. 4. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 5. Minnesota Department of Health, St Paul, Minnesota, USA. 6. California Emerging Infections Program, Oakland, USA. 7. Connecticut Department of Public Health, Hartford, USA. 8. Colorado Department of Public Health and Environment, Denver, USA. 9. Vanderbilt University Medical Center, Nashville, Tennessee, USA. 10. Georgia Emerging Infections Program, Atlanta, USA.
Abstract
Background: 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 the Centers for Disease Control and Prevention'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 to 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 per 100000 among whites and 7.60 per 100000 among blacks (rate ratio [RR], 1.66; 95% confidence interval [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 (RR, 1.05; 95% CI, .92-1.20). Conclusions: The racial disparity in invasive community-associated MRSA rates was largely explained by socioeconomic factors. The specific factors that underlie the association between census tract-level socioeconomic measures and MRSA incidence, which may include modifiable social (eg, 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. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Background: 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 the Centers for Disease Control and Prevention'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 to 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 per 100000 among whites and 7.60 per 100000 among blacks (rate ratio [RR], 1.66; 95% confidence interval [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 (RR, 1.05; 95% CI, .92-1.20). Conclusions: The racial disparity in invasive community-associated MRSA rates was largely explained by socioeconomic factors. The specific factors that underlie the association between census tract-level socioeconomic measures and MRSA incidence, which may include modifiable social (eg, 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. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Entities:
Keywords:
antibiotic resistance; methicillin-resistant Staphylococcus aureus; racial disparities; social determinants of health
Authors: Scott K Fridkin; Jeffrey C Hageman; Melissa Morrison; Laurie Thomson Sanza; Kathryn Como-Sabetti; John A Jernigan; Kathleen Harriman; Lee H Harrison; Ruth Lynfield; Monica M Farley Journal: N Engl J Med Date: 2005-04-07 Impact factor: 91.245
Authors: Alexander J Kallen; Yi Mu; Sandra Bulens; Arthur Reingold; Susan Petit; Ken Gershman; Susan M Ray; Lee H Harrison; Ruth Lynfield; Ghinwa Dumyati; John M Townes; William Schaffner; Priti R Patel; Scott K Fridkin Journal: JAMA Date: 2010-08-11 Impact factor: 56.272
Authors: Joan A Casey; Frank C Curriero; Sara E Cosgrove; Keeve E Nachman; Brian S Schwartz Journal: JAMA Intern Med Date: 2013-11-25 Impact factor: 21.873
Authors: Raymund Dantes; Yi Mu; Ruth Belflower; Deborah Aragon; Ghinwa Dumyati; Lee H Harrison; Fernanda C Lessa; Ruth Lynfield; Joelle Nadle; Susan Petit; Susan M Ray; William Schaffner; John Townes; Scott Fridkin Journal: JAMA Intern Med Date: 2013-11-25 Impact factor: 21.873
Authors: Rachel J Gorwitz; Deanna Kruszon-Moran; Sigrid K McAllister; Geraldine McQuillan; Linda K McDougal; Gregory E Fosheim; Bette J Jensen; George Killgore; Fred C Tenover; Matthew J Kuehnert Journal: J Infect Dis Date: 2008-05-01 Impact factor: 5.226
Authors: Nicole Gualandi; Yi Mu; Wendy M Bamberg; Ghinwa Dumyati; Lee H Harrison; Lindsey Lesher; Joelle Nadle; Sue Petit; Susan M Ray; William Schaffner; John Townes; Mariana McDonald; Isaac See Journal: Clin Infect Dis Date: 2018-09-28 Impact factor: 9.079
Authors: Angela R Wateska; Mary Patricia Nowalk; Chyongchiou J Lin; Lee H Harrison; William Schaffner; Richard K Zimmerman; Kenneth J Smith Journal: Am J Prev Med Date: 2020-01-28 Impact factor: 5.043
Authors: Angela R Wateska; Mary Patricia Nowalk; Chyongchiou J Lin; Lee H Harrison; William Schaffner; Richard K Zimmerman; Kenneth J Smith Journal: Vaccine Date: 2019-03-04 Impact factor: 3.641
Authors: Koen B Pouwels; F Christiaan K Dolk; David R M Smith; Timo Smieszek; Julie V Robotham Journal: J Antimicrob Chemother Date: 2018-02-01 Impact factor: 5.790
Authors: Angela R Wateska; Mary Patricia Nowalk; Chyongchiou J Lin; Lee H Harrison; William Schaffner; Richard K Zimmerman; Kenneth J Smith Journal: J Community Health Date: 2020-02
Authors: Kelly A Jackson; Runa H Gokhale; Joelle Nadle; Susan M Ray; Ghinwa Dumyati; William Schaffner; David C Ham; Shelley S Magill; Ruth Lynfield; Isaac See Journal: Clin Infect Dis Date: 2020-03-03 Impact factor: 9.079
Authors: Angela R Wateska; Mary Patricia Nowalk; Chyongchiou J Lin; Lee H Harrison; William Schaffner; Richard K Zimmerman; Kenneth J Smith Journal: J Am Geriatr Soc Date: 2020-02-22 Impact factor: 5.562