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Trends in the incidence of Clostridioides difficile infection in adults and the elderly insured by Medicaid compared to commercial insurance or Medicare only

Published online by Cambridge University Press:  09 September 2022

Margaret A. Olsen Open the ORCID record for Margaret A. Olsen [Opens in a new window] ,
Dustin Stwalley Open the ORCID record for Dustin Stwalley [Opens in a new window] ,
Andrew D. Tipping ,
Matthew R. Keller ,
Holly Yu  and
Erik R. Dubberke Open the ORCID record for Erik R. Dubberke [Opens in a new window]
Margaret A. Olsen*
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri Department of Surgery, Washington University School of Medicine, St Louis, Missouri
Dustin Stwalley
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Andrew D. Tipping
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Matthew R. Keller
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Holly Yu
Affiliation:
Pfizer, Inc, Pearl River, New York (Present affiliation: Missouri Institute of Mental Health, St Louis, Missouri [A.D.T.])
Erik R. Dubberke*
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
*
Author for correspondence: Margaret A. Olsen, E-mail: molsen@wustl.edu. Or Erik R. Dubberke, E-mail: edubberk@wustl.edu
Author for correspondence: Margaret A. Olsen, E-mail: molsen@wustl.edu. Or Erik R. Dubberke, E-mail: edubberk@wustl.edu
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Abstract

Objective:

Few data are available to quantify the Clostridioides difficile infection (CDI) burden in US adults depending on Medicaid insurance status; thus, we sought to contribute to this body of information.

Methods:

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.

Results:

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; P < .001) but were stable in those commercially insured (25.9 to 24.8 per 100,000 PY; P = .33). In the elderly HCA-CDI rates declined from 2011 to 2017 in the Medicare-only population (403 to 318 per 100,000 PY; P < .001) and the Medicare plus Medicaid population (1,770 to 1,163 per 100,000 PY; P < .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).

Conclusions:

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 7 , July 2023 , pp. 1076 - 1084
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENCATION. The preliminary results of this study were presented at the 31st European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), on July 9–12, 2021, in Vienna, Austria, held virtually.

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