Association of neighborhood-level factors with hospitalization for community-associated methicillin-resistant Staphylococcus aureus, New York City, 2006: a multilevel observational study

• Published in: BMC infectious diseases Vol. 13; no. 1; p. 84
• Main Authors: Farr, Amanda M, Marx, Melissa A, Weiss, Don, Nash, Denis
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.02.2013; BioMed Central
• Subjects: Acquired immune deficiency syndrome; Admission and discharge; Adolescent; Adult; Aged; Aged, 80 and over; AIDS; Analysis; Child; Child, Preschool; Community-acquired infections; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Drug resistance in microorganisms; Female; HIV; HIV infection; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Human immunodeficiency virus; Humans; Infant; Infection; Male; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; New York City - epidemiology; Public health; Residence Characteristics; Retrospective Studies; Risk Factors; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcus aureus; Staphylococcus aureus infections; Surveys; Young Adult; New York City; New York; United States > US
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-13-84

Hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic variation across neighborhoods. While individual-level risk factors, such as age, sex, HIV infection, and diabetes have been described, the role of neighborhood-level factors (e.g., neighborhood HIV prevalence or income) has not been examined. To explore plausible neighborhood-level factors associated with CA-MRSA-related hospitalizations, a retrospective analysis was conducted using New York City hospital discharges from 2006 and New York City-specific survey and health department surveillance data. CA-MRSA-related hospitalizations were identified using diagnosis codes and admission information. Associations were determined by using sex-specific multilevel logistic regression. The CA-MRSA hospitalization rate varied by more than six-fold across New York City neighborhoods. Females hospitalized with CA-MRSA had more than twice the odds of residing in neighborhoods in the highest quintile of HIV prevalence (adjusted odds ratio [AOR](Q5 vs. Q1) 2.3, 95% CI: 1.2, 2.7). Both males and females hospitalized with CA-MRSA had nearly twice the odds of residing in neighborhoods with moderately high proportion of men who have sex with men (MSM) residing in the neighborhood (males: AOR(Q4 vs. Q1) 1.7, 95% CI: 1.1, 2.7; females: AOR(Q4 vs. Q1) 2.0, 95% CI: 1.1, 3.6); but this association did not hold for neighborhoods in the highest quintile (males: AOR(Q5 vs. Q1) 1.2, 95% CI: 0.76, 1.8; females: AOR(Q5 vs. Q1) 1.5, 95% CI: 0.82, 2.7). Neighborhood-level characteristics were associated with CA-MRSA hospitalization odds, independent of individual-level risk factors, and may contribute to the population-level burden of CA-MRSA infection.