Exploration and measurement of inequities in the occurrence of hospital adverse events in Colombia

Introduction: Device-associated infections (DAIs) are preventable adverse events that represent a critical issue for patient safety. These infections, including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP), can be influenced by geographic factors, insurance schemes, sex, and age, leading to differential risks and creating another form of health inequity. Objective: To explore and measure inequities in patient safety associated with DAIs in Colombia, using data from the SIVIGILA system (2012–2022). Methods: This observational, analytical study analyzed data on CLABSI, CAUTI, and VAP reported in SIVIGILA. Incidence rates were estimated using random-effects metamodels adjusted for region, year, and device-days. Inequities were formally assessed using coefficients of variation, group deviations, risk differences, and relative risks across comparison groups (region, age group, municipalities). Results: A total of 750 aggregate reports covering over 49,101 DAI events from 2012 to 2022 were analyzed. CLABSI accounted for 44.4% of events. DAIs were more frequent among men (55.2%), in the contributory insurance scheme (49.3%), followed by the subsidized scheme (42.1%), with only 3% occurring in individuals without affiliation to the general social security system (SGSSS). Mortality associated with these events was 19.9%. Bivariate analyses and metamodels revealed inequities in DAI occurrence, particularly in areas with lower access and resources. DAIs showed disparities across departments, regions, sexes, and age groups. Most municipalities and departments reported rates below 3 cases per 1,000 device-days for CLABSI and VAP, but some departments exhibited risks up to four times higher. CAUTI showed a more homogeneous risk distribution. Conclusions: The study highlights significant inequities in the occurrence of DAIs in Colombia. These findings underscore the need for regional and targeted strategies to enhance patient safety and reduce disparities in healthcare.