Title: Sociodemographic Inequalities in Urinary Tract Infection in 2 Large California Health Systems.

Authors: Casey, Joan A; Rudolph, Kara E; Robinson, Sarah C; Bruxvoort, Katia; Raphael, Eva; Hong, Vennis; Pressman, Alice; Morello-Frosch, Rachel; Wei, Rong X; Tartof, Sara Y

Published In Open Forum Infect Dis, (2021 Jun)

Abstract: BACKGROUND: Urinary tract infection (UTI) accounts for a substantial portion of outpatient visits and antibiotic prescriptions in the United States. Few studies have considered sociodemographic factors including low socioeconomic status (SES)-which may increase residential crowding, inappropriate antibiotic prescribing, or comorbidities-as UTI or multidrug-resistant (MDR) UTI risk factors. METHODS: We used 2015-2017 electronic health record data from 2 California health care systems to assess whether 3 sociodemographic factors-use of Medicaid, use of an interpreter, and census tract-level deprivation-were associated with overall UTI or MDR UTI. UTIs resistant to ≥3 antibiotic classes were considered MDR. RESULTS: Analyses included 601 352 UTI cases, 1 303 455 controls, and 424 977 urinary Escherichia coli isolates from Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. The MDR prevalence was 10.4% at KPSC and 12.8% at Sutter Health. All 3 sociodemographic factors (ie, use of Medicaid, using an interpreter, and community deprivation) were associated increased risk of MDR UTI. For example, using an interpreter was associated with a 36% (relative risk [RR], 1.36; 95% CI, 1.31 to 1.40) and 28% (RR, 1.28; 95% CI, 1.22 to 1.34) increased risk of MDR UTI at KPSC and Sutter Health, respectively, adjusted for SES and other potential confounding variables. The 3 sociodemographic factors were only weakly associated with UTI overall. CONCLUSIONS: We found low SES and use of an interpreter to be novel risk factors for MDR UTI in the United States.

PubMed ID: 34189179

MeSH Terms: No MeSH terms associated with this publication