A population-based matched cohort study examining the mortality and costs of patients with community-onset Clostridium difficile infection identified using emergency department visits and hospital admissions

• Published in: PloS one Vol. 12; no. 3; p. e0172410
• Main Authors: Nanwa, Natasha, Sander, Beate, Krahn, Murray, Daneman, Nick, Lu, Hong, Austin, Peter C., Govindarajan, Anand, Rosella, Laura C., Cadarette, Suzanne M., Kwong, Jeffrey C.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.03.2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Analysis; Antibiotics; Bacteria; Biology and Life Sciences; Canada - epidemiology; Cancer; Care and treatment; Child; Clostridium difficile; Clostridium difficile - pathogenicity; Clostridium infections; Clostridium Infections - economics; Clostridium Infections - microbiology; Clostridium Infections - mortality; Clostridium Infections - physiopathology; Codes; Cohort analysis; Cohort Studies; Collaboration; Communities; Confidence intervals; Costs; Costs and Cost Analysis - economics; Cross Infection - economics; Cross Infection - microbiology; Cross Infection - mortality; Cross Infection - physiopathology; Economic aspects; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Epidemiology; Female; Foreign exchange rates; Health care; Health care expenditures; Health care networks; Health care policy; Health economics; Health sciences; Hospital admission and discharge; Hospital emergency services; Hospitalization; Hospitalization - economics; Hospitals; Humans; Infections; Infectious diseases; Length of Stay - economics; Male; Medicine and Health Sciences; Middle Aged; Mortality; Patients; People and Places; Personal health; Pharmacy; Population; Population studies; Population-based studies; Public health; Survival; Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0172410

Few studies have evaluated the mortality or quantified the economic burden of community-onset Clostridium difficile infection (CDI). We estimated the attributable mortality and costs of community-onset CDI. We conducted a population-based matched cohort study. We identified incident subjects with community-onset CDI using health administrative data (emergency department visits and hospital admissions) in Ontario, Canada between January 1, 2003 and December 31, 2010. We propensity-score matched each infected subject to one uninfected subject and followed subjects in the cohort until December 31, 2011. We evaluated all-cause mortality and costs (unadjusted and adjusted for survival) from the healthcare payer perspective (2014 Canadian dollars). During our study period, we identified 7,950 infected subjects. The mean age was 63.5 years (standard deviation = 22.0), 62.7% were female, and 45.0% were very high users of the healthcare system. The relative risk for 30-day, 180-day, and 1-year mortality were 7.32 (95% confidence interval [CI], 5.94-9.02), 3.55 (95%CI, 3.17-3.97), and 2.59 (95%CI, 2.37-2.83), respectively. Mean attributable cumulative 30-day, 180-day, and 1-year costs (unadjusted for survival) were $7,434 (95%CI, $7,122-$7,762), $12,517 (95%CI, $11,687-$13,366), and $13,217 (95%CI, $12,062-$14,388). Mean attributable cumulative 1-, 2-, and 3-year costs (adjusted for survival) were $10,700 (95%CI, $9,811-$11,645), $13,312 (95%CI, $12,024-$14,682), and $15,812 (95%CI, $14,159-$17,571). Infected subjects had considerably higher risk of all-cause mortality and costs compared with uninfected subjects. This study provides insight on an understudied patient group. Our study findings will facilitate assessment of interventions to prevent community-onset CDI.