The Role of Race and Ethnicity in Antibiotic Prescribing for Inpatient Pneumonia Cases Restricted; Files Only
Evans, David (Spring 2024)
Abstract
Background
The connection between inpatient antibiotic prescription trends and the racial and ethnic composition has not been conclusively determined. This research sought to clarify how antibiotics are used among a diverse inpatient population, with the goal of identifying potential biases that could influence antibiotic prescribing for pneumonia patients.
Methods
Data for this research was obtained from the Clinical Data Warehouse, which covered all patients admitted to the Hospital Medicine Service at four Emory Healthcare Hospitals and who received antibiotics between January 1, 2019, and July 7, 2022. The study included patients belonging to different racial and ethnic categories such as Black non-Hispanic, White non-Hispanic, Hispanic or Latino, and Other. Cases of pneumonia were identified using ICD-10 codes for various types of pneumonia. Both univariate and multivariable GEE logistic regression models were utilized to forecast selection of antibiotic classes (as defined by CDC’s NHSN Antibiotic Use Option) based on patient demographics, underlying medical conditions, co-infections, and factors related to Pseudomonas aeruginosa activity indicated by ICD-10 codes.
Results
The study involved 17,533 patients and 23,508 hospitalizations. Of these, 29% had an ICD-10 code for pneumonia. Most patients were White non-Hispanic (50%) or Black non-Hispanic (42%), while a smaller percentage were Hispanic or Latino (3%). Broad-spectrum agents targeting community-onset infections were used in 71% of cases, broad-spectrum agents targeting healthcare-acquired pathogens in 47%, and anti-MRSA agents in 41%. Race and ethnicity influenced the prescription of specific antibiotic groups for pneumonia cases after controlling for all other variables. Non-Hispanic Black patients were less likely to receive BS-HO antibiotics compared to Non-Hispanic White or Latino patients but more likely to receive BS-CO antibiotics. However, there was no association found between Non-Hispanic Black and White patients regarding receiving anti-MRSA antibiotics.
Conclusion
Our results found that the choice of antibiotics for pneumonia patients in hospital medicine services was impacted by their underlying medical conditions, type of infection, and indicators for Pseudomonas aeruginosa activity. Even after accounting for different factors, there were still differences in antibiotic selection, especially related to race and ethnicity. Black patients were around 19% less likely to be prescribed BS-HO agents and 20% more likely to receive BS-CO agents compared to White patients. These findings highlight the necessity for additional research into the reasons behind these disparities in antibiotic prescription practices in the inpatient setting.
Table of Contents
1. Introduction………………………………………………………………………………1
2. Methods…………………………………………………………………………………..4
3. Results……………………………………………………………………………………8
4. Discussion………………………………………………………………………………..11
5. Conclusion & Public Health Implications……………………………………………….13
6. References………………………………………………………………………………..14
7. Tables & Figures………………………………………………………………………...17
8. Appendix…………………………………………………………………………………27
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File download under embargo until 20 May 2026 | 2024-04-09 12:01:08 -0400 | File download under embargo until 20 May 2026 |
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