Dubberke Erik R, Olsen Margaret A, Stwalley Dustin, Kelly Ciarán P, Gerding Dale N, Young-Xu Yinong, Mahé Cedric
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America.
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America.
PLoS One. 2016 Feb 9;11(2):e0146822. doi: 10.1371/journal.pone.0146822. eCollection 2016.
Population attributable risk percent (PAR%) is an epidemiological tool that provides an estimate of the percent reduction in total disease burden if that disease could be entirely eliminated among a subpopulation. As such, PAR% is used to efficiently target prevention interventions. Due to significant limitations in current Clostridium difficile Infection (CDI) prevention practices and the development of new approaches to prevent CDI, such as vaccination, we determined the PAR% for CDI in various subpopulations in the Medicare 5% random sample.
This was a retrospective cohort study using the 2009 Medicare 5% random sample. Comorbidities, infections, and healthcare exposures during the 12 months prior to CDI were identified. CDI incidence and PAR% were calculated for each condition/exposure. Easy to identify subpopulations that could be targeted from prevention interventions were identified based on PAR%.
There were 1,465,927 Medicare beneficiaries with 9,401 CDI cases for an incidence of 677/100,000 persons. Subpopulations representing less than 15% of the entire population and with a PAR% ≥ 30% were identified. These included deficiency anemia (PAR% = 37.9%), congestive heart failure (PAR% = 30.2%), fluid and electrolyte disorders (PAR% = 29.6%), urinary tract infections (PAR% = 40.5%), pneumonia (PAR% = 35.2%), emergent hospitalization (PAR% = 48.5%) and invasive procedures (PAR% = 38.9%). Stratification by age and hospital exposures indicates hospital exposures are more strongly associated with CDI than age.
Small and identifiable subpopulations that account for relatively large proportions of CDI cases in the elderly were identified. These data can be used to target specific subpopulations for CDI prevention interventions.
人群归因风险百分比（PAR%）是一种流行病学工具，用于估计如果某疾病能在亚人群中完全消除，总疾病负担将降低的百分比。因此，PAR%用于有效定位预防干预措施。由于当前艰难梭菌感染（CDI）预防措施存在重大局限性，且出现了如疫苗接种等预防CDI的新方法，我们在医疗保险5%随机样本中确定了不同亚人群中CDI的PAR%。
这是一项使用2009年医疗保险5%随机样本的回顾性队列研究。确定CDI发生前12个月内的合并症、感染和医疗暴露情况。计算每种疾病/暴露情况的CDI发病率和PAR%。根据PAR%确定易于识别的、可作为预防干预目标的亚人群。
有1,465,927名医疗保险受益人，其中9,401例CDI病例，发病率为677/100,000人。确定了占总人口不到15%且PAR%≥ 30%的亚人群。这些包括缺铁性贫血（PAR% = 37.9%）、充血性心力衰竭（PAR% = 30.2%）、体液和电解质紊乱（PAR% = 29.6%）尿路感染（PAR% = 40.5%）、肺炎（PAR% = 35.2%）、急诊住院（PAR% = 48.5%）和侵入性操作（PAR% = 38.9%）。按年龄和医院暴露分层表明，医院暴露与CDI的关联比年龄更强。
确定了在老年人中占CDI病例比例相对较大的、规模小且可识别的亚人群。这些数据可用于针对特定亚人群进行CDI预防干预。
