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Mortality and Costs in Clostridium difficile Infection Among the Elderly in the United States

Published online by Cambridge University Press:  30 August 2016

Andrew F. Shorr ,
Marya D. Zilberberg ,
Li Wang ,
Onur Baser  and
Holly Yu
Andrew F. Shorr
Affiliation:
Washington Hospital Center, Washington, DC
Marya D. Zilberberg*
Affiliation:
EviMed Research Group, Goshen, Massachusetts School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
Li Wang
Affiliation:
STATinMED Research, Ann Arbor, Michigan
Onur Baser
Affiliation:
STATinMED Research, Ann Arbor, Michigan Center for Innovation & Outcomes Research, Department of Surgery, Columbia University, New York, New York
Holly Yu
Affiliation:
Pfizer, Collegeville, Pennsylvania.
*
Address correspondence to Marya D. Zilberberg, MD, MPH, PO Box 303, Goshen, MA 01032 (evimedgroup@gmail.com).
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Abstract

OBJECTIVE

To examine attributable mortality and costs of Clostridium difficile infection (CDI) in the Medicare population.

DESIGN

A population-based cohort study among US adults aged at least 65 years in the 2008–2010 Medicare 5% sample, with follow-up of 12 months.

PATIENTS

Incident CDI episode was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification code of 008.45 and no other occurrences within the preceding 12 months. To quantify the adjusted mortality and costs we developed a 1:1 propensity-matched sample of CDI and non-CDI patients.

RESULTS

Among 1,165,165 patients included, 6,838 (0.6%) had a CDI episode in 2009 (82.5% healthcare-associated). Patients with CDI were older (mean [SD] age, 81.0±8.0 vs 77.0±7.7 years, P<.001), were more likely to come from the Northeast (27.4% vs 18.6%, P<.001), and had a higher comorbidity burden (Charlson score, 4.6±3.3 vs 1.7±2.1, P<.001). Hospitalizations (63.2% vs 6.0%, P<.001) and antibiotics (33.9% vs 12.5%, P<.001) within the prior 90 days were more common in the group with CDI. In the propensity-adjusted analysis, CDI was associated with near doubling of both mortality (42.6% vs 23.4%, P<.001) and total healthcare costs ($64,807±$66,480 vs $38,128±$46,485, P<.001).

CONCLUSIONS

Among elderly patients, CDI is associated with an increase in adjusted mortality and healthcare costs following a CDI episode. Nationwide annually this equals 240,000 patients with CDI, 46,000 potential deaths, and more than $6 billion in costs.

Infect Control Hosp Epidemiol 2016;1–6

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 11 , November 2016 , pp. 1331 - 1336
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

A.F.S. and M.D.Z. contributed equally to this article.

Presented in part: 55th Interscience Conference on Antimicrobial Agents and Chemotherapy meeting; San Diego, California; September 18–21, 2015.

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