(1399) Hospital-Acquired Infections: Discrepancies and Outcomes

Introduction: Healthcare disparities represent a significant challenge in the quest for equitable health outcomes across different populations. Specifically, mortality rates have been observed to differ notably between ethnic groups in hospital settings, a concern that prompts further investigation into the root causes and potential mitigation strategies. We hypothesized that non-English language preference and minority group membership would affect outcomes from hospital onset sepsis.

Methods: A retrospective analysis using the Medical Information Mart for Intensive Care (MIMIC)-IV database from 2008-2019 was performed using Bayesian logistic regression with modestly informative priors (N(0,1)). Two patient groups were identified: suspected sepsis, defined as initiation of antibiotics and blood cultures drawn ≥48 hours after admission, and hospital onset bacteremia (HOB), identified through a positive blood culture drawn ≥48 hours after admission. We evaluated the rates of in-hospital mortality and ICU admission across non-English preference, primary insurance as Medicaid, and racial and ethnic minority group.

Results: In the suspected sepsis group (n=12,041), 29.2% identified as a racial or ethnic minority, 11.3% had a non-English preference, and 6.9% had Medicaid as their primary insurance. In the HOB group (n=2,822), 31.3% identified as a racial or ethnic minority, 11.9% had a non-English preference, and 10.2% had Medicaid as their primary insurance. In the suspected sepsis group, the racial and ethnic minority group was associated with increased hospital mortality (OR:1.19) with no difference in ICU admission rates. For the HOB group, the in-hospital mortality rates were moderately to highly statistically significant for increased risk of death in non-English language preference and racial and ethnic minority groups (OR:1.25 and OR:1.17) while ICU admission rates were significantly decreased in all groups.

Conclusions: Patients with confirmed bacteremia overall demonstrated higher in-hospital mortality and lower ICU admission rates for minority groups. A similar trend was seen for patients of racial and ethnic minority groups in the suspected sepsis cohort. These results suggest the presence of a disparity in patient care for those in minority groups.