Evaluating racial and ethnic disparities in antibiotic treatment for pneumonia patients in a major academic health system

Abstract

Objective: Examine the relationship between patients’ race and prescriber antibiotic choice while accounting for differences in underlying illness and infection severity. Design: Retrospective cohort analysis. Setting: Acute care facilities within an academic healthcare system. Patients: Adult inpatients from January 2019 through June 2022 discharged from the Hospital Medicine Service with an ICD-10 Code for Pneumonia. Methods: We describe variability in days of therapy of antimicrobials with activity against Pseudomonas aeruginosa (anti-Pseudomonas agents) or against MRSA (anti-MRSA agents), by patient’s race and ethnicity. We estimated the likelihood of receipt of any anti-Pseudomonas agents by race and modeled the effect of race on rate of use, adjusting for age, severity, and indication. Results: 5,820 patients with 6,700 encounters were included. After adjusting for broad indication, severity, underlying illness, and age, use of anti-Pseudomonas agents were less likely among non-Hispanic Black patients than other race groups, although this effect was limited to younger patients (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.29, 0.70), and not older ones (aOR 0.98; 95% CI 0.85, 1.13); use of anti-MRSA agents were similar between groups. Among patients receiving any anti-Pseudomonas agents, Black patients received them for relatively lower proportion of their inpatient stay (incidence rate ratio 0.91; 95% CI 0.87, 0.96). Conclusions: We found difference in use of anti-Pseudomonas agents between non-Hispanic Black patients and other patients that could not be easily explained by indications or underlying illness, suggesting unmeasured factors may be playing a role in treatment decisions.