Racial, Ethnic, and Socioeconomic Disparities in Pediatric Community-Acquired Methicillin-resistant Staphylococcus aureus: A Systematic Review and Meta-Analysis Open Access

McNulty, Lily (Spring 2023)

Permanent URL: https://etd.library.emory.edu/concern/etds/zk51vj42x?locale=en


Background: Marginalized communities suffer from poorer health outcomes due to systemic and structural discrimination. Antimicrobial resistance is an emerging health threat, yet it’s unclear to what extent community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) burdens these groups.

Methods: A scoping review was conducted to identify studies that reported colonization or infection with 8 bacteria of interest by participant race, ethnicity, or socioeconomic status (SES). Studies that reported pediatric CA-MRSA were included for a systematic review and meta-analysis. Two independent reviewers extracted data using Covidence and conducted quality assessments. Meta-analyses and subgroup analyses were conducted using RStudio version 4.2.2.

Results: Fifteen studies including 609,641 children from 5 countries were included. Compared to children of non-minority race or ethnicity (e.g., White, Jewish), minority children (i.e., Black, Hispanic, Bedouin, Aboriginal) had a higher risk for MRSA versus methicillin-susceptible S. aureus (MSSA) (RR: 1.51, 95% CI [1.26; 1.80], I2=44%). A sensitivity analysis with low-bias studies (n=3) showed a significant difference between minority and non-minority groups when comparing the risk of MRSA versus no MRSA (RR: 2.02, 95% CI [1.18; 3.46], I2=66%). Compared to higher SES children (e.g., private insurance, low deprivation), children of lower SES had a higher risk for MRSA versus MSSA (RR: 1.54, 95% CI [1.17; 2.02]) in studies with a low risk of bias.

Conclusion: Minority children have statistically significant higher risks of MRSA colonization or infection across multiple countries. More research is needed to identify and dismantle systems that perpetuate barriers to equitable healthcare, prevention, and treatment of CA-MRSA. 

Table of Contents

Tables and Figures

Collaborating authors

1. Chapter 1: Introduction

1.1. Introduction (1)

1.2. Rationale and Problem Statement (3)

1.3. Purpose Statement (4)

1.4. Research Question (4)

1.5. Significance Statement (5) 

2. Chapter 2: Comprehensive Review of the Literature

2.1. Major Threats to Human Health and Antimicrobial Resistance (6)

2.2. Disparities in the burden of Infectious Diseases (9)

2.3. Methicillin-resistant Staphylococcus aureus (MRSA) (10)

2.4. Disparities in MRSA and CA-MRSA (13)

2.5. Disparities in Pediatric MRSA and CA-MRSA (16)

2.6. Concluding Comments (17)

3. Chapter 3: Methodology

3.1. Eligibility criteria (18)

3.2. Information sources and search strategy (19)

3.3. Data collection process (20)

3.4. Quality assessment (21)

3.5. Data analysis (22)

4. Chapter 4: Results

4.1. Study characteristics (24)

4.2. Risk of bias outcomes (28)

4.3. Meta-analysis results (29)

5. Chapter 5: Discussion and Conclusion

5.1. Discussion of results (38)

5.2. Conclusion (42)

5.3. Limitations and strengths (43)

6. Chapter 6: Public Health Implications and Recommendations (46)

7.  References (48)

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Last modified

Primary PDF

Supplemental Files