Association Between the Vulnerability to Hospital-Acquired Infection and Health Care Utilization: Evidence From the National Inpatient Sample From 2016 to 2020.

OBJECTIVES

This study aims to identify the vulnerability of hospital-acquired infection (HAI) and differences in health care utilization among patients with HAIs across various patient and hospital factors.

METHODS

Using the United States National Inpatient Sample (2016-2020), we identified hospitalized patients with a length of stay ≥3 days (n=18,931,779; national estimates=94,568,871). We examined the occurrence of HAIs, trends, and risk factors associated with HAI-occurrence, in-hospital death, and health care utilization, measured by hospital charges and length of stay (LOS). Multivariate survey logistic regression was used to identify predictors of HAIs and in-hospital death, and survey linear regression was applied to evaluate the association between HAIs and hospital charges. Subgroup analyses were conducted by sociodemographic factors.

RESULTS

Among 94,658,871 nationwide inpatients, 23.4% experienced HAIs. The proportion of HAI cases gradually increased over time along with health care utilization. Patients who were older, female, Hispanic, low-income, or covered by Medicare/Medicaid showed significantly higher risks of HAIs. HAIs were also associated with increased odds of in-hospital death, higher hospital charges, and longer LOS.

CONCLUSIONS

Various sociodemographic and hospital factors were associated with greater vulnerability to HAIs, higher in-hospital mortality, longer hospitalizations, and greater health care costs. These findings emphasize the heterogeneity in vulnerability to HAIs across sociodemographic and hospital contexts and highlight the potential value of risk stratification in informing patient safety efforts.