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

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 (anti- agents) or against MRSA (anti-MRSA agents), by patient's race and ethnicity. We estimated the likelihood of receipt of any anti- 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- 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- 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- 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.