Racial disparities in Clostridioides difficile testing in three southeastern US hospitals

OBJECTIVE: To analyze <em>Clostridioides difficile</em> testing in 3 hospitals in central North Carolina to validate previous racial health-disparity findings. METHODS: We completed a retrospective analysis of inpatient <em>C. difficile</em> tests from 2015 to 2021 at 3 university-affiliated hospitals in North Carolina. We calculated the number of <em>C. difficile</em> tests per 1,000 patient days stratified by race: White, Black, and non-White, non-Black (NWNB). We defined a unique <em>C. difficile</em> test as one that occurred in an inpatient unit with a matching laboratory accession ID and on differing calendar days. Tests were evaluated overall, by hospital, by year, and by positivity rate. RESULTS: In total, 35,160 <em>C. difficile</em> tests and 2,571,850 patient days across all 3 hospitals from 2015 to 2021 were analyzed. The median number of <em>C. difficile</em> tests per 1,000 patient days was 13.85 (interquartile range [IQR], 9.88-16.07). Among all <em>C. difficile</em> tests, 5,225 (15%) were positive. White patients were administered more <em>C. difficile</em> tests (14.46 per 1,000 patient days) than Black patients (12.96; <em>P</em> &lt; .0001) or NWNB race patients (10.27; <em>P</em> &lt; .0001). Black patients were administered more tests than NWNB patients (<em>P</em> &lt; .0001). White patients tested positive at a similar rate to Black patients (15% vs 15%; <em>P</em> = .3655) and higher than NWNB individuals (12%; <em>P</em> = .0061), and Black patients tested positive at a higher rate than NWNB patients (<em>P</em> = .0024). CONCLUSION: White patients received more <em>C. difficile</em> tests than Black and NWNB patient groups when controlling for race patient days. Future studies should control for comorbidities and investigate community onset of <em>C. difficile</em> by race and ethnicity.