S2143 A Nationwide Analysis of Low-Income Patients Hospitalization Outcomes in C. difficile Infection

Introduction: Clostridioides difficile infection (CDI) remains a significant cause of morbidity and healthcare utilization in the U.S. Socioeconomic status is a known determinant of health outcomes, yet the impact of low income on hospitalization outcomes in CDI has not been well characterized on a national scale. This study aims to evaluate differences in inpatient outcomes, including mortality, length of stay, and total hospital charges, among low-income patients hospitalized with CDI using a large, nationally representative database. Methods: Data were extracted from the National Inpatient Sample (NIS) Database for the years 2015 to 2022. The NIS searched for hospitalizations of adult patients with low income (below $50,000) with documented CDI using the International Classification of Diseases Tenth Revision codes. Multivariate logistic was used to adjust for confounders. The primary outcome was inpatient mortality. SPSS software was used for statistical analysis. Results: This study included 402,061 with CDI, of which 107,195 (27.0%) patients with low income at the time of their hospitalization. The inpatient mortality analysis from the dataset reveals that 6,968 patients with low income and CDI died during hospitalization, accounting for approximately 30% of all inpatient deaths (24,068 total deaths). Multivariate regression showed that patients with low income had higher inpatient mortality (odds ratio [OR] 1.407, confidence interval [CI] 1.369-1.419, P < 0.001). Secondary analysis, showed low income patients had higher odds of having cardiogenic shock (OR 1.407, CI 1.380-1.435, P< 0.001), vasopressor use (OR 1.342, CI 1.327-1.358, P< 0.001), anemia (OR 1.379, CI 1.376-1.383, P< 0.001), and acute kidney failure (AKI) (OR 1.375, CI 1.370-1.379, P < 0.001), Metabolic dysfunction-associated steatotic liver disease (MASLD) (OR 1.366, CI 1.348-1.383, P < 0.001), and diabetes (OR 1.427, CI 1.401-1.454, P < 0.001). Conclusion: This demonstrates low-income patients hospitalized with CDI face significantly worse clinical outcomes compared to higher-income counterparts. They experienced higher inpatient mortality and increased odds of complications including cardiogenic shock, vasopressor use, anemia, and AKI. Additionally, comorbid conditions such as MASLD and diabetes were more prevalent. These findings highlight the disproportionate burden of CDI on socioeconomically disadvantaged patients and need for targeted public health interventions, improved access to care, and enhanced inpatient management strategies in this vulnerable group.