TY - JOUR
T1 - Increasing age has limited impact on risk of Clostridium difficile infection in an elderly population
AU - Olsen, Margaret A.
AU - Stwalley, Dustin
AU - Demont, Clarisse
AU - Dubberke, Erik R.
N1 - Funding Information:
Financial support. This work was supported by Sanofi Pasteur. The sponsor participated in study design, interpretation of data, and final review of the manuscript. Access to data and additional services were provided by the Washington University Center for Administrative Data Research, supported in part by grant UL1 TR000448 from the National Center for Advancing Translational Sciences of the National Institutes of Health and grant R24 HS19455 through the Agency for Healthcare Research and Quality.
Funding Information:
Disclosures. M. A. O.: grants and personal fees from Sanofi Pasteur, during the conduct of the study; personal fees from Pfizer, outside the submitted work. D. S.: none. C. D.: employee of Sanofi. E. R. D.: grants from Sanofi, during the conduct of the study; personal fees from Sanofi, grants and personal fees from Pfizer, personal fees from Synthetic Biologics, personal fees from Valneva, personal fees from Abbott, personal fees from Biofire, grants and personal fees from Rebiotix, grants and personal fees from Merck, outside the submitted work.
Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background. Numerous studies have found increased risk of Clostridium difficile infection (CDI) with increasing age. We hypothesized that increased CDI risk in an elderly population is due to poorer overall health status with older age. Methods. A total of 174 903 persons aged 66 years and older coded for CDI in 2011 were identified using Medicare claims data. The comparison population consisted of 1 453 867 uninfected persons. Potential risk factors for CDI were identified in the prior 12 months and organized into categories, including infections, acute noninfectious conditions, chronic comorbidities, frailty indicators, and health care utilization. Multivariable logistic regression models with CDI as the dependent variable were used to determine the categories with the biggest impact on model performance. Results. Increasing age was associated with progressively increasing risk of CDI in univariate analysis, with 5-fold increased risk of CDI in 94-95-year-old persons compared with those aged 66-67 years. Independent risk factors for CDI with the highest effect sizes included septicemia (odds ratio [OR], 4.1), emergency hospitalization(s) (OR, 3.9), short-term skilled nursing facility stay(s) (OR, 2.7), diverticulitis (OR, 2.2), and pneumonia (OR, 2.1). Exclusion of age from the full model had no impact on model performance. Exclusion of acute noninfectious conditions followed by frailty indicators resulted in lower c-statistics and poor model fit. Further exclusion of health care utilization variables resulted in a large drop in the c-statistic. Conclusions. Age did not improve CDI risk prediction after controlling for a wide variety of infections, other acute conditions, frailty indicators, and prior health care utilization.
AB - Background. Numerous studies have found increased risk of Clostridium difficile infection (CDI) with increasing age. We hypothesized that increased CDI risk in an elderly population is due to poorer overall health status with older age. Methods. A total of 174 903 persons aged 66 years and older coded for CDI in 2011 were identified using Medicare claims data. The comparison population consisted of 1 453 867 uninfected persons. Potential risk factors for CDI were identified in the prior 12 months and organized into categories, including infections, acute noninfectious conditions, chronic comorbidities, frailty indicators, and health care utilization. Multivariable logistic regression models with CDI as the dependent variable were used to determine the categories with the biggest impact on model performance. Results. Increasing age was associated with progressively increasing risk of CDI in univariate analysis, with 5-fold increased risk of CDI in 94-95-year-old persons compared with those aged 66-67 years. Independent risk factors for CDI with the highest effect sizes included septicemia (odds ratio [OR], 4.1), emergency hospitalization(s) (OR, 3.9), short-term skilled nursing facility stay(s) (OR, 2.7), diverticulitis (OR, 2.2), and pneumonia (OR, 2.1). Exclusion of age from the full model had no impact on model performance. Exclusion of acute noninfectious conditions followed by frailty indicators resulted in lower c-statistics and poor model fit. Further exclusion of health care utilization variables resulted in a large drop in the c-statistic. Conclusions. Age did not improve CDI risk prediction after controlling for a wide variety of infections, other acute conditions, frailty indicators, and prior health care utilization.
KW - Age
KW - Clostridium difficile
KW - Epidemiology
KW - Medicare
KW - Risk factor
UR - http://www.scopus.com/inward/record.url?scp=85050885119&partnerID=8YFLogxK
U2 - 10.1093/ofid/ofy160
DO - 10.1093/ofid/ofy160
M3 - Article
C2 - 30046643
AN - SCOPUS:85050885119
VL - 5
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
SN - 2328-8957
IS - 7
M1 - ofy160
ER -