The Impact of the COVID-19 Pandemic on Clostridioides Difficile Infection Outcomes and Disparities in Care in New York City

Purpose: Social determinants and comorbid conditions are known to influence Clostridioides Difficile infection (CDI) outcomes. The COVID-19 pandemic exacerbated overall health care disparities, and although CDI rates were stable if not lower, patients with CDI had worsened morbidity and mortality. Our purpose is to study the effect of social factors and recently resolved or concomitant COVID-19 infection on CDI outcomes in a metropolitan health system during the pandemic. Methods: This was a retrospective, logistic regression of 338 patients extracted from a database of hospitalized patients with CDI at a tertiary urban center in New York City between April 2020 and October 2021. The primary endpoint was severity of infection, and secondary endpoints were intensive care stay and length of hospitalization as well as CDI recurrence, mortality and colectomy within one year. Results: Patients insured under Medicaid were more likely to experience mortality during admission (UOR = 2.66, AOR = 3.45, 95%CI: 1.43, 8.29), while all publicly insured patients had higher 1 year mortality (UOR = 2.43, AOR = 2.71, 95%CI: 1.21, 6.06). Concomitant COVID and CDI was associated with severe or fulminant infection (53.8% vs. 84.6%, p = 0.03) compared to no COVID, with no difference in mortality (13.4% vs. 18.2%, p = 0.65). Conclusion: There were demographic and insurance-based disparities in CDI care. While patients with concomitant COVID had more severe or fulminant infections, there was no difference in mortality in these patient groups as would have been expected based on severity classification.