482. Association between Socioeconomic Status Factors and Incidence of Community-Associated Clostridium difficile Infection Utilizing Factor Analysis—United States, 2014–2015

作     者：Kimberly Skrobarcek Yi Mu Jennifer Ahern Zintars Beldavs Geoff Brousseau Ghinwa Dumyati Monica M Farley Stacy Holzbauer Marion A Kainer James I Meek Rebecca Perlmutter Erin C Phipps Lisa G Winston Alice Y Guh 

作者机构：Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia University of California at Berkeley Berkeley California Oregon Health Authority Portland Oregon Colorado Department of Public Health and Environment Denver Colorado NY Emerging Infections Program Center for Community Health and Prevention University of Rochester Medical Center Rochester New York Department of Medicine Emory University School of Medicine and Atlanta VA Medical Center Atlanta Georgia Minnesota Department of Health Saint Paul Minnesota Communicable and Environmental Diseases and Emergency Preparedness Tennessee Department of Public Health Nashville Tennessee Connecticut Emerging Infections Program Yale School of Public Health New Haven Connecticut Maryland Department of Health Baltimore Maryland New Mexico Emerging Infections Program University of New Mexico Albuquerque New Mexico Medicine University of California San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center San Francisco California 

出 版 物：《Open Forum Infect Dis》 

年 卷 期：2018年第5卷第SUPPL 1期

页      面：S179-S179页

摘      要：Background Traditionally a healthcare-associated infection, Clostridium difficile infection (CDI) is increasingly emerging in communities. Health disparities in CDI exist, but the social determinants of health that influence community-associated (CA) CDI are unknown. We used factor analysis and disparate data sources to identify area-based socioeconomic status (SES) factors associated with CA-CDI incidence. Methods CDC’s Emerging Infections Program conducts population-based CDI surveillance in 35 US counties. A CA-CDI case is defined as a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization in a person aged ≥1 year without a positive test in the prior 8 weeks or an overnight stay in a healthcare facility in the prior 12 weeks. 2014–2015 CA-CDI case addresses were geocoded to a 2010 census tract (CT) and incidence rates were calculated. CT-level SES variables were obtained from the 2011–2015 American Community Survey. The Health Resources and Services Administration provided medically underserved area (MUA) designations. Exploratory factor analysis transformed 15 highly correlated SES variables into threefactors using scree plot and Kaiser criteria: “Low Income, “Foreign-born, and “High Income. To account for CT-level clustering, a negative binomial generalized linear mixed model was used to evaluate the associations of these factors and MUA with CA-CDI incidence, adjusting for age, sex, race and diagnostic test. Results Of 13,903 CA-CDI geocoded cases, 63% were female, 80% were white, and 36% were aged ≥65 years. Annual CA-CDI incidence was 63.4/100,000 persons. In multivariable analysis, “Low Income (rate ratio [RR]: 1.09; 95% confidence interval [CI]: 1.05–1.13) and “High Income (RR: 0.90; CI: 0.87–0.93) were significantly associated with CA-CDI incidence. Conclusion Factor analysis was instrumental in identifying key drivers of disparities among interrelated SES variables. Low-income areas were surprisingly associated