Major ArticleBurden of Clostridium difficile infection: Associated hospitalization in a cohort of middle-aged and older adults
Section snippets
Study population and data sources
We used data from the Sax Institute's 45 and Up Study, a prospective cohort study of healthy aging involving 267,153 men and women aged 45 years and older from the general population of the Australian state of New South Wales (NSW) (2006 population, 6.8 million persons).6 Participants were randomly selected from the Medicare Australia database, which includes all citizens and permanent residents of Australia, and some temporary residents and refugees. Approximately 10% of the population of NSW
Results
There were 641 hospitalizations with CDI during the study period. The average age at hospitalization was 76.7 ± 11.2 years, and 45% of patients were men. There were 712,178 hospitalizations without CDI and the average age of these patients was 70.4 ± 11.4 years, 53% were men. Table 1 summarizes the demographic characteristics of patients hospitalized with and without CDI during the study period.
Of those patients hospitalized with CDI, 7.3% (47 out of 641) died during hospitalization. The
Discussion
CDI-associated hospitalizations are longer, more costly, and have a higher proportion of in-hospital deaths compared with hospitalizations without CDI in middle-aged and older Australians. Whereas this may not translate to a large total burden on the health care system because they constitute only a small proportion of total hospital admissions (12,683 cases of hospital-identified CDI in public hospitals in Australia during 2011-20123 and 0.2% of all public hospital admissions14), the burden on
Conclusions
We found that patients hospitalized with CDI have relatively lengthy hospital stays and high costs, and are more likely to die in hospital then those with non-CDI hospitalizations. The increased length of stay, costs, and in-hospital deaths associated with CDI are found across patients with a range of diagnoses. An appreciation of the burden of CDI hospitalization is important to ensure proper allocation of health care resources for CDI prevention and treatment efforts.
Acknowledgements
The authors thank the many thousands of people who participated in the 45 and Up Study.
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YC received the 2014 Prime Minister's Australia Asia Postgraduate Scholarship from the Australian Government Department of Education and Training (No. 3929_2014), and a Higher Degree Research Tuition Fee Scholarship from the Australian National University. BL is funded by an Australian National Health & Medical Research Council Career Development Fellowship.
This research was completed using data collected through the 45 and Up Study (www.saxinstitute.org.au). The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW and partners, including the National Heart Foundation of Australia (New South Wales Division); New South Wales Ministry of Health; New South Wales Government Family & Community Services—Careers, Ageing, and Disability Inclusion; and the Australian Red Cross Blood Service.
Conflicts of interest: None to report.