JPEN J Parenter Enteral Nutr. 2024 Jun 26. doi: 10.1002/jpen.2665. Online ahead of print.

Susan A Gutierrez ¹, Sy Han Chiou ^2 3, Vikram Raghu ⁴, Conrad R Cole ⁵, Sue Rhee ¹, Jennifer C Lai ⁶, Sharad I Wadhwani ¹

Author information

¹Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.

²Department of Surgery, University of California, San Francisco, San Francisco, California, USA.

³Department of Statistics and Data Science, Southern Methodist University, Dallas, Texas, USA.

⁴Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

⁵Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.

⁶Department of Medicine, University of California, San Francisco, San Francisco, California, USA.

Abstract

Background: Low neighborhood income is linked with increased hospitalizations for central line-associated bloodstream infections (CLABSIs) in pediatric short bowel syndrome (SBS). We assessed whether this relationship varies by hospital center.

Methods: We performed a retrospective cohort study using the Pediatric Health Information System (2018-2023) database for patients <18 years old with SBS (N = 1210) at 24 hospitals in the United States. Using 2015 US Census data, we determined the estimated median household income of each patient's zip code. Hospital-level neighborhood income was defined as the median of the estimated median household income among patients at each hospital. We applied an extension of Cox regression to assess risk for CLABSI hospitalization.

Results: Among 1210 children with 5255 hospitalizations, most were <1 year on initial admission (53%), male (58%), and publicly insured (69%). Hospitals serving low-income neighborhoods served more female (46% vs 39%), Black (29% vs 22%), and Hispanic (22% vs 16%) patients with public insurance (72% vs 65%) residing in the southern United States (47% vs 21%). In univariate analysis, low hospital-level neighborhood income was associated with increased risk of CLABSI hospitalization (rate ratio [RR], 1.48; 95% CI, 1.21-1.83; P < 0.001). These findings persisted in multivariate analysis (RR, 1.43; 95% CI, 1.10-1.84; P < 0.01) after adjusting for race, ethnicity, insurance, region, and patient-level neighborhood income.

Conclusion: Hospitals serving predominantly low-income neighborhoods bear a heavier burden of CLABSI hospitalizations for all their patients across the socioeconomic spectrum. Hospital initiatives focused on CLABSI prevention may be pivotal in addressing this disparity.