Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
Infect Control Hosp Epidemiol. 2023 Jul;44(7):1076-1084. doi: 10.1017/ice.2022.208. Epub 2022 Sep 9.
Few data are available to quantify the infection (CDI) burden in US adults depending on Medicaid insurance status; thus, we sought to contribute to this body of information.
Retrospective cohort study to identify adults with codes for CDI from 2011 to 2017 in MarketScan commercial and Medicaid databases (for those aged 25-64 years) and the CMS Medicare database (for those aged ≥65 years). CDI was categorized as healthcare-facility-associated (HCA-CDI) and community-associated CDI (CA-CDI). CDI incidence rates were compared by year, insurer, and age group.
The overall CDI incidence in the elderly was 3.1-fold higher in persons insured by Medicare plus Medicaid than in those insured by Medicare only (1,935 vs 618 per 100,000 person years (PY)), and the CDI incidence was 2.7-fold higher in younger adults with Medicaid compared to commercial insurance (195 vs 73 per 100,000 PY). From 2011 to 2017, HCA-CDI rates declined in the younger Medicaid population (124.0 to 95.2 per 100,000 PY; < .001) but were stable in those commercially insured (25.9 to 24.8 per 100,000 PY; = .33). In the elderly HCA-CDI rates declined from 2011 to 2017 in the Medicare-only population (403 to 318 per 100,000 PY; < .001) and the Medicare plus Medicaid population (1,770 to 1,163 per 100,000 PY; < .002). Persons with chronic medical conditions and those with immunocompromising conditions insured by Medicaid had 2.8- and 2.7-fold higher CDI incidence compared to the commercially insured population, respectively. The incidence of CDI was lowest in Medicaid and commercially insured younger adults without chronic medical or immunosuppressive conditions (67.5 and 45.6 per 100,000 PY, respectively).
Although HCA-CDI incidence decreased from 2011 to 2017 in elderly and younger adults insured by Medicaid, the burden of CDI remains much higher in low-income adults insured by Medicaid.
根据医疗补助保险状况，量化美国成年人感染（CDI）负担的数据很少；因此，我们试图为此提供信息。
回顾性队列研究，以确定 2011 年至 2017 年市场扫描商业和医疗补助数据库（年龄 25-64 岁）和 CMS 医疗保险数据库（年龄≥65 岁）中 CDI 代码的成年人。将 CDI 分为医疗保健机构相关（HCA-CDI）和社区相关 CDI（CA-CDI）。按年、保险公司和年龄组比较 CDI 发病率。
医疗保险加医疗补助保险的老年人 CDI 总发病率是仅医疗保险的 3.1 倍（每 100000 人年 1935 比 618 例），年轻成年人中医疗补助保险的 CDI 发病率是商业保险的 2.7 倍（每 100000 人年 195 比 73 例）。从 2011 年到 2017 年，年轻的 Medicaid 人群中的 HCA-CDI 发病率下降（每 100000 人年 124.0 至 95.2；<.001），而商业保险人群中则保持稳定（每 100000 人年 25.9 至 24.8；=.33）。在老年人中，从 2011 年到 2017 年，只有医疗保险的人群中 HCA-CDI 发病率从 403 降至 318（每 100000 人年；<.001），医疗保险加医疗补助的人群中从 1770 降至 1163（每 100000 人年；<.002）。患有慢性疾病和免疫抑制状况的 Medicaid 保险患者的 CDI 发病率分别比商业保险患者高 2.8 倍和 2.7 倍。没有慢性疾病或免疫抑制状况的 Medicaid 和商业保险年轻成年人的 CDI 发病率最低（每 100000 人年分别为 67.5 和 45.6）。
尽管 Medicaid 保险的老年和年轻成年人的 HCA-CDI 发病率从 2011 年到 2017 年有所下降，但低收入成年人的 CDI 负担仍然高得多。
