Nickel et al.: Race, Rurality, and the Risk of Health Care-Associated Infections

In Intersection of Race and Rurality with Health Care-Associated Infections and Subsequent Outcomes, authors Katelin B. Nickel, Anne M. Butler, Karen E. Joynt Maddox, Victoria J. Fraser, Jason P. Burnham, Jennie H. Kwon (all Washington University Medicine), and Hannah Kinzer (Brown School, Washington University) examine how social and geographic factors such as race and rurality affect access to equitable healthcare.

This study focuses on health care-associated infections (HAIs), which are infections contracted by patients while receiving inpatient care in healthcare facilities. These include blood infections, respiratory infections, and other infections that can increase health risks and may contribute to mortality.

Data on these infections were collected from a hospital database, which included electronic health records across a network of hospitals. The patient pool was limited to those who were over 18 years of age and admitted to the hospital for more than 48 hours. The pool was further limited to exclusively black and white racial groups, which were subdivided as either urban or rural. This yielded a pool of 214,955 patients, 33.2% of whom were identified as black urban, 0.5% as black rural, 50.4% as white urban, and 15.9% as white rural. Of these individuals, infections developed among 2.7% of black urban patients, 4.1% of black rural patients, 3.1% of white urban patients, and 3.9% of white rural patients. These results demonstrate that black urban patients had a decreased risk of HAIs as compared to their white urban counterparts. All rural patients had a greater risk of HAIs than their urban counterparts, with black rural patients being at the greatest risk.

The authors indicate that this research highlights the inequitable and systemic barriers to receiving safe and quality healthcare due to patient race and geographic residence. They recognized limitations to their data because they received most of their information from urban and suburban hospitals. Nonetheless, they emphasize the need for further research into these issues as well as the need for healthcare systems to be cognizant of these inequities when treating patients.