Racial and Socioeconomic Disparities in Necrotizing Soft-Tissue Infection

Abstract

Background: Necrotizing soft-tissue infection (NSTI) is a medical emergency. We investigated the impact of racial, socioeconomic disparities, and comorbidities on mortality, complications, length of stay, and charges in patients with NSTI. Methods: Data were acquired from the National Inpatient Sample from Q4 2015 to 2017. ICD-10, Clinical Modification codes were utilized to identify relevant cases. Logistic regression was used to assess socioeconomic, racial, and health risk factors for adverse outcomes in NSTI patients. Results: Of 16,071,053 cases identified during the study period, 15,078 (0.094%) NSTI cases were recognized. Black patients had increased odds of amputation (OR 1.40 95% CI 1.24–1.58, p < 0.001), prolonged hospital stay (OR 1.40 95% CI 1.24–1.58, p < 0.001), excessive charges (OR 1.22 95% CI 1.03–1.43, p = 0.019), and adverse discharge disposition (OR 1.32 95% CI 1.19–1.46, p < 0.001) compared to white patients. Hispanic patients had increased odds of mortality (OR 1.30 95% CI 1.05–1.60, p = 0.014) and amputation (OR 1.21 95% CI 1.04–1.42, p = 0.016) compared to white patients. Medicare patients had increased odds of mortality (OR 1.35 95% CI 1.09–1.67, p = 0.006), Medicaid patients had increased odd of amputation (OR 1.33 95% CI 1.17–1.51, p < 0.001) and prolonged LOS (OR 1.33 95% CI 1.17–1.51, p < 0.001). Patients in the lower income quartiles had decreased odds of amputation compared to the highest income quartile, including the 26th to 50th income quartile (OR 0.84 95% CI 0.73–0.98, p = 0.022) and 51st to 75th income quartile (OR 0.84 95% CI 0.73–0.98, p = 0.022). Conclusions: Racial and socioeconomic disparities exist for patients being treated for NSTIs.

Keywords

• necrotizing soft tissue infection
• national inpatient sample
• outcomes
• race
• socioeconomics