J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 11, November 2022, pages 474-486

Trends and Disparities in Outcomes of Clostridioides difficile Infection Hospitalizations in the United States: A Ten-Year Joinpoint Trend Analysis

Figure 1. Trend in the adjusted incidence of CDI among all hospitalizations from 2010 to 2019. *Statistically significant. APC: annual percentage change; CDI: Clostridioides difficile infection.

Figure 2. Trend in the mortality rate for hospitalizations with CDI (sex subgroup analysis). CDI: Clostridioides difficile infection.

Figure 3. Trend in the mortality rate for hospitalizations with CDI (racial subgroup analysis). CDI: Clostridioides difficile infection.

Figure 4. Trends in adjusted CDI admission rate from 2010 to 2019. *Statistically significant. APC: annual percentage change; CDI: Clostridioides difficile infection.

Figure 5. Trend in mortality rate hospitalizations with a principal admitting diagnosis of CDI (sex subgroup analysis). CDI: Clostridioides difficile infection.

Figure 6. Trend in mortality rate hospitalizations with a principal admitting diagnosis of CDI (racial subgroup analysis). CDI: Clostridioides difficile infection.

**Table 1.** Biodemographic Data of Hospitalizations With CDI
Variable	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	P-value
CCI: Charlson comorbidity index; CDI: Clostridioides difficile infection; MHOI: median household income national quartile for patient ZIP code; SD: standard deviation from the mean.
Total hospitalizations, million, N = 305	31.4	31.5	30.7	30.0	29.8	30.2	30.2	30.4	30.3	30.2
Total hospitalizations with CDI, N = 3,318,533	314,147	352,831	352,580	347,835	352,290	363,385	351,040	322,545	298,930	262,950
CDI incidence rate, per 100,000 hospitalizations	1001	1120	1148	1159	1182	1203	1162	1061	987	871
Mean age ± SD, years	68.9 ± 17.2	69.1 ± 17.4	67.9 ± 16.9	67.3 ± 17.0	66.6 ± 17.0	66.3 ± 17.0	66.0 ± 16.9	66.2 ± 16.8	66.3 ± 16.5	66.2 ± 16.5	< 0.001
Age categories, %											< 0.001
Young adults (18 - 44)	9.8	9.5	10.5	11.1	11.7	12.0	12.0	11.8	11.4	11.6
Middle aged (45 - 64)	25.3	25.2	26.3	27.1	28.3	28.8	29.3	28.9	29.2	29.0
Elderly (≥ 65)	64.9	65.3	63.1	61.8	60.0	59.2	58.7	59.3	59.4	59.4
Female, %	57.7	58.8	58.9	58.4	58.6	58.2	57.6	57.4	57.3	57.4	< 0.001
Race, %											< 0.001
White	67.3	68.2	71.6	70.9	71.1	71.0	71.1	71.5	72.0	72.2
Black	11.8	11.8	12.0	12.3	12.3	12.6	12.4	12.6	12.7	13.1
Hispanic	6.2	7.3	6.9	7.4	7.3	7.5	7.9	8.0	8.2	8.0
Others	14.6	12.7	9.4	9.4	9.3	8.9	8.6	7.9	7.0	6.7
CCI score, %											< 0.001
0	23.4	22.4	22.8	22.6	22.4	25.5	17.1	16.9	16.1	16.3
1	19.7	19.2	18.7	18.3	18.1	16.9	17.3	16.9	16.3	15.8
2	19.4	18.9	18.7	18.8	17.9	17.0	17.7	17.4	17.4	16.8
≥ 3	37.6	39.5	39.8	40.3	41.6	40.6	47.9	48.8	50.2	51.2
Primary payer, %											< 0.001
Medicare	69.8	71.4	70.6	69.6	67.9	67.4	66.8	67.3	67.7	66.9
Medicaid	9.4	8.9	9.2	9.7	11.6	12.0	12.7	12.3	12.0	12.3
Private insurance	18.5	17.5	17.6	17.9	18.5	18.7	18.5	18.3	18.1	18.3
No insurance	2.4	2.2	2.6	2.9	2.1	2.0	2.0	2.1	2.2	2.5
MHOI quartile, %											< 0.001
1	25.1	25.9	27.2	27.0	27.3	29.2	29.0	28.6	28.2	28.8
2	24.8	23.8	24.4	26.2	27.6	24.9	26.0	27.0	27.9	26.0
3	25.6	26.3	24.9	24.8	23.8	24.7	24.4	24.0	24.4	24.8
4	24.6	24.0	23.6	22.0	21.3	21.3	20.6	20.4	19.5	20.5
Hospital bed-size, %											< 0.001
Small	10.7	11.3	13.2	13.0	17.5	17.0	17.5	18.9	20.0	21.7
Medium	23.2	23.8	25.1	25.4	28.7	29.1	28.3	28.7	28.5	28.1
Large	66.2	64.9	61.7	61.6	53.8	54.0	54.3	52.4	51.5	50.3
Hospital region, %											0.513
Northeast	23.8	22.1	22.0	21.5	20.4	19.5	18.8	18.5	18.7	19.1
Midwest	25.2	24.6	24.4	24.0	23.6	23.2	23.4	24.5	25.2	25.0
South	33.9	34.2	34.8	36.1	36.9	37.8	37.4	37.4	37.8	37.4
West	17.2	19.1	18.8	18.5	19.2	19.6	20.5	19.6	18.4	18.5
Location/teaching status of hospital, %											< 0.001
Rural	9.9	9.8	9.4	9.9	7.9	8.4	8.2	8.7	9.0	9.0
Urban nonteaching	43.0	41.7	38.4	37.3	26.3	27.0	26.5	23.2	20.1	18.7
Urban teaching	47.1	48.6	52.3	52.8	65.7	64.6	65.3	68.1	70.9	72.3

Table 1. Biodemographic Data of Hospitalizations With CDI

Variable

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

P-value

CCI: Charlson comorbidity index; CDI: Clostridioides difficile infection; MHOI: median household income national quartile for patient ZIP code; SD: standard deviation from the mean.

Total hospitalizations, million, N = 305

31.4

31.5

30.7

30.0

29.8

30.2

30.4

30.3

30.2

Total hospitalizations with CDI, N = 3,318,533

314,147

352,831

352,580

347,835

352,290

363,385

351,040

322,545

298,930

262,950

CDI incidence rate, per 100,000 hospitalizations

1001

1120

1148

1159

1182

1203

1162

1061

987

871

Mean age ± SD, years

68.9 ± 17.2

69.1 ± 17.4

67.9 ± 16.9

67.3 ± 17.0

66.6 ± 17.0

66.3 ± 17.0

66.0 ± 16.9

66.2 ± 16.8

66.3 ± 16.5

66.2 ± 16.5

< 0.001

Age categories, %

< 0.001

Young adults (18 - 44)

9.8

9.5

10.5

11.1

11.7

12.0

11.8

11.4

11.6

Middle aged (45 - 64)

25.3

25.2

26.3

27.1

28.3

28.8

29.3

28.9

29.2

29.0

Elderly (≥ 65)

64.9

65.3

63.1

61.8

60.0

59.2

58.7

59.3

59.4

Female, %

57.7

58.8

58.9

58.4

58.6

58.2

57.6

57.4

57.3

57.4

< 0.001

Race, %

< 0.001

White

67.3

68.2

71.6

70.9

71.1

71.0

71.1

71.5

72.0

72.2

Black

11.8

12.0

12.3

12.6

12.4

12.6

12.7

13.1

Hispanic

6.2

7.3

6.9

7.4

7.3

7.5

7.9

8.0

8.2

8.0

Others

14.6

12.7

9.4

9.3

8.9

8.6

7.9

7.0

6.7

CCI score, %

< 0.001

23.4

22.4

22.8

22.6

22.4

25.5

17.1

16.9

16.1

16.3

19.7

19.2

18.7

18.3

18.1

16.9

17.3

16.9

16.3

15.8

19.4

18.9

18.7

18.8

17.9

17.0

17.7

17.4

16.8

≥ 3

37.6

39.5

39.8

40.3

41.6

40.6

47.9

48.8

50.2

51.2

Primary payer, %

< 0.001

Medicare

69.8

71.4

70.6

69.6

67.9

67.4

66.8

67.3

67.7

66.9

Medicaid

9.4

8.9

9.2

9.7

11.6

12.0

12.7

12.3

12.0

12.3

Private insurance

18.5

17.5

17.6

17.9

18.5

18.7

18.5

18.3

18.1

18.3

No insurance

2.4

2.2

2.6

2.9

2.1

2.0

2.1

2.2

2.5

MHOI quartile, %

< 0.001

25.1

25.9

27.2

27.0

27.3

29.2

29.0

28.6

28.2

28.8

24.8

23.8

24.4

26.2

27.6

24.9

26.0

27.0

27.9

26.0

25.6

26.3

24.9

24.8

23.8

24.7

24.4

24.0

24.4

24.8

24.6

24.0

23.6

22.0

21.3

20.6

20.4

19.5

20.5

Hospital bed-size, %

< 0.001

Small

10.7

11.3

13.2

13.0

17.5

17.0

17.5

18.9

20.0

21.7

Medium

23.2

23.8

25.1

25.4

28.7

29.1

28.3

28.7

28.5

28.1

Large

66.2

64.9

61.7

61.6

53.8

54.0

54.3

52.4

51.5

50.3

Hospital region, %

0.513

Northeast

23.8

22.1

22.0

21.5

20.4

19.5

18.8

18.5

18.7

19.1

Midwest

25.2

24.6

24.4

24.0

23.6

23.2

23.4

24.5

25.2

25.0

South

33.9

34.2

34.8

36.1

36.9

37.8

37.4

37.8

37.4

West

17.2

19.1

18.8

18.5

19.2

19.6

20.5

19.6

18.4

18.5

Location/teaching status of hospital, %

< 0.001

Rural

9.9

9.8

9.4

9.9

7.9

8.4

8.2

8.7

9.0

Urban nonteaching

43.0

41.7

38.4

37.3

26.3

27.0

26.5

23.2

20.1

18.7

Urban teaching

47.1

48.6

52.3

52.8

65.7

64.6

65.3

68.1

70.9

72.3

**Table 2.** Outcomes of Hospitalizations With CDI
Variable	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	P-value
LOS: length of hospital stay; MHOI: median household income national quartile for patient ZIP code; THC: total hospital charges.
Mortality rate, %	8.4	7.8	7.3	7.3	6.8	6.7	6.3	6.3	6.0	5.8	< 0.001
Mean LOS, days	11.6	11.1	10.6	10.4	10.5	10.2	10.1	9.9	9.9	9.8	< 0.001
Mean THC, US$	93,521	98,649	95,012	96,702	99,163	99,015	105,120	104,320	105,737	108,357	< 0.001
Mortality rate among females, %	7.8	7.2	6.7	6.6	6.2	6.1	5.8	5.6	5.6	5.2	< 0.001
Mean LOS among females, days	10.7	10.2	9.8	9.6	9.7	9.5	9.3	9.2	9.1	9.1	< 0.001
Mean THC among females, US$	82,867	85,353	82,873	84,388	87,269	87,730	92,126	91,928	92,296	94,855	< 0.001
Mortality rate among males, %	9.2	8.6	8.3	8.2	7.7	7.5	7.0	7.1	6.6	6.6	< 0.001
Mean LOS among males, days	12.9	12.3	11.8	11.6	11.6	11.1	11.2	10.8	11.0	10.8	< 0.001
Mean THC among males, US$	108,090	117,624	112,425	114,003	116,022	114,722	122,790	121,033	123,781	126,518	< 0.001
Mortality rate among Whites, %	8.5	7.6	7.1	7.2	6.8	6.6	5.9	6.0	5.8	5.5	< 0.001
Mean LOS among Whites, days	10.9	10.6	10.0	9.8	9.9	9.5	9.4	9.2	9.2	9.1	< 0.001
Mean THC among Whites, US$	85,867	91,878	86,144	87,836	90,581	88,521	92,767	92,202	93,560	95,882	< 0.001
Mortality rate among Blacks, %	8.3	8.4	8.0	7.6	7.0	7.1	7.0	6.7	6.7	6.6	< 0.001
Mean LOS among Blacks, days	15.1	13.4	12.6	12.5	12.6	12.2	12.4	12.0	12.1	12.3	< 0.001
Mean THC among Blacks, US$	114,929	117,850	111,413	115,006	116,800	118,518	125,221	123,995	126,158	125,050	< 0.001
Mortality rate among Hispanics, %	9.2	8.5	7.3	7.6	6.5	6.5	6.7	6.5	5.9	6.1	< 0.001
Mean LOS among Hispanics, days	14.5	12.7	11.9	11.9	11.5	11.8	11.5	11.0	10.7	10.9	< 0.001
Mean THC among Hispanics, US$	140,462	146,273	139,345	140,193	139,799	142,846	151,262	146,579	145,180	153,481	< 0.001
Mortality rate among MHOI quartile 1, %	8.6	7.6	7.5	7.3	6.8	6.9	6.6	6.5	6.3	5.8	< 0.001
Mean LOS among MHOI quartile 1, days	12.3	11.4	10.9	10.9	10.9	10.6	10.6	10.3	10.3	10.2	< 0.001
Mean THC among MHOI quartile 1, US$	93,751	98,105	92,696	94,431	99,437	100,402	104,595	105,356	105,723	105,756	< 0.001
Mortality rate among MHOI quartile 4, %	8.7	8.2	7.4	7.8	6.9	6.6	6.2	6.3	6.1	6.0	< 0.001
Mean LOS among MHOI quartile 4, days	11.5	11.0	10.6	10.5	10.5	10.1	10.2	10.0	9.9	9.7	< 0.001
Mean THC among MHOI quartile 4, US$	98,532	99,403	103,701	106,578	109,072	105,922	116,261	117,153	118,548	117,650	< 0.001

Table 2. Outcomes of Hospitalizations With CDI

Variable

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

P-value

LOS: length of hospital stay; MHOI: median household income national quartile for patient ZIP code; THC: total hospital charges.

Mortality rate, %

8.4

7.8

7.3

6.8

6.7

6.3

6.0

5.8

< 0.001

Mean LOS, days

11.6

11.1

10.6

10.4

10.5

10.2

10.1

9.9

9.8

< 0.001

Mean THC, US$

93,521

98,649

95,012

96,702

99,163

99,015

105,120

104,320

105,737

108,357

< 0.001

Mortality rate among females, %

7.8

7.2

6.7

6.6

6.2

6.1

5.8

5.6

5.2

< 0.001

Mean LOS among females, days

10.7

10.2

9.8

9.6

9.7

9.5

9.3

9.2

9.1

< 0.001

Mean THC among females, US$

82,867

85,353

82,873

84,388

87,269

87,730

92,126

91,928

92,296

94,855

< 0.001

Mortality rate among males, %

9.2

8.6

8.3

8.2

7.7

7.5

7.0

7.1

6.6

< 0.001

Mean LOS among males, days

12.9

12.3

11.8

11.6

11.1

11.2

10.8

11.0

10.8

< 0.001

Mean THC among males, US$

108,090

117,624

112,425

114,003

116,022

114,722

122,790

121,033

123,781

126,518

< 0.001

Mortality rate among Whites, %

8.5

7.6

7.1

7.2

6.8

6.6

5.9

6.0

5.8

5.5

< 0.001

Mean LOS among Whites, days

10.9

10.6

10.0

9.8

9.9

9.5

9.4

9.2

9.1

< 0.001

Mean THC among Whites, US$

85,867

91,878

86,144

87,836

90,581

88,521

92,767

92,202

93,560

95,882

< 0.001

Mortality rate among Blacks, %

8.3

8.4

8.0

7.6

7.0

7.1

7.0

6.7

6.6

< 0.001

Mean LOS among Blacks, days

15.1

13.4

12.6

12.5

12.6

12.2

12.4

12.0

12.1

12.3

< 0.001

Mean THC among Blacks, US$

114,929

117,850

111,413

115,006

116,800

118,518

125,221

123,995

126,158

125,050

< 0.001

Mortality rate among Hispanics, %

9.2

8.5

7.3

7.6

6.5

6.7

6.5

5.9

6.1

< 0.001

Mean LOS among Hispanics, days

14.5

12.7

11.9

11.5

11.8

11.5

11.0

10.7

10.9

< 0.001

Mean THC among Hispanics, US$

140,462

146,273

139,345

140,193

139,799

142,846

151,262

146,579

145,180

153,481

< 0.001

Mortality rate among MHOI quartile 1, %

8.6

7.6

7.5

7.3

6.8

6.9

6.6

6.5

6.3

5.8

< 0.001

Mean LOS among MHOI quartile 1, days

12.3

11.4

10.9

10.6

10.3

10.2

< 0.001

Mean THC among MHOI quartile 1, US$

93,751

98,105

92,696

94,431

99,437

100,402

104,595

105,356

105,723

105,756

< 0.001

Mortality rate among MHOI quartile 4, %

8.7

8.2

7.4

7.8

6.9

6.6

6.2

6.3

6.1

6.0

< 0.001

Mean LOS among MHOI quartile 4, days

11.5

11.0

10.6

10.5

10.1

10.2

10.0

9.9

9.7

< 0.001

Mean THC among MHOI quartile 4, US$

98,532

99,403

103,701

106,578

109,072

105,922

116,261

117,153

118,548

117,650

< 0.001

**Table 3.** Biodemographic Data of Hospitalizations With Principal Admitting Diagnosis of CDI
Variable	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	P-value
CCI: Charlson comorbidity index; CDI: Clostridioides difficile infection; MHOI: median household income national quartile for patient ZIP code; SD: standard deviation from the mean.
Total principal admissions for CDI	103,845	116,138	115,830	107,730	104,695	106,905	103,135	93,810	86,285	76,325
CDI admission rate, per 100,000 hospitalizations	331	369	377	359	351	354	342	309	285	253
Mean age ± SD, years	69.4 ± 17.5	69.2 ± 18.0	67.9 ± 17.5	67.3 ± 17.7	66.4 ± 17.8	65.9 ± 17.9	65.8 ± 17.7	66.1 ± 17.5	66.5 ± 17.2	66.6 ± 16.9	< 0.001
Age categories, %											< 0.001
Young adults	10.0	10.5	11.8	12.6	13.4	14.0	13.7	13.1	12.4	12.2
Middle aged	23.7	23.4	24.5	25.8	26.9	27.4	27.9	27.9	27.5	27.5
Elderly	66.3	66.1	63.7	61.7	59.7	58.6	58.5	59.0	60.1	60.3
Female, %	64.3	65.8	65.3	65.1	65.5	64.8	65.1	64.2	64.4	63.9	0.002
Race, %											< 0.001
White	71.2	71.5	75.2	75.2	74.8	75.0	75.2	75.8	75.9	75.8
Black	8.9	9.2	9.6	9.8	10.1	10.7	10.3	10.4	10.6	11.0
Hispanic	5.9	7.1	6.8	6.8	7.2	6.9	7.5	7.5	7.8	7.5
Others	14.0	12.2	8.4	8.3	7.9	7.4	7.0	6.3	5.8	5.7
CCI score, %											< 0.001
0	31.7	31.3	32.0	32.8	32.1	33.2	26.8	25.9	24.5	24.5
1	22.1	21.8	20.8	20.4	21.3	20.3	21.0	20.5	19.9	19.5
2	17.8	17.9	17.6	17.2	16.3	16.1	17.0	17.1	17.2	16.7
≥ 3	28.4	29.1	29.6	29.6	30.4	30.5	35.2	36.6	38.4	39.3
Primary payer, %											< 0.001
Medicare	70.5	71.1	70.5	68.5	67.3	66.0	66.2	66.9	68.4	66.8
Medicaid	7.1	7.3	7.9	8.1	10.8	11.0	11.6	10.9	10.4	10.4
Private insurance	20.0	19.1	18.8	20.2	19.6	20.8	20.0	19.8	18.8	20.1
No insurance	2.5	2.5	2.9	3.2	2.3	2.1	2.3	2.4	2.4	2.7
MHOI quartile, %											< 0.001
1	23.9	25.4	26.9	26.9	26.9	28.6	27.9	27.8	27.2	27.8
2	26.1	24.2	24.5	27.0	28.0	25.5	27.0	27.7	28.3	26.5
3	25.7	26.5	25.2	24.8	24.2	25.0	24.7	23.8	24.7	24.6
4	24.4	23.9	23.5	21.3	20.8	20.9	20.4	20.8	19.9	21.1
Hospital bed-size, %											< 0.001
Small	12.3	13.0	15.1	15.0	19.8	19.5	20.8	21.4	23.1	24.4
Medium	24.3	25.2	25.8	26.6	30.1	30.2	29.1	30.2	29.7	29.6
Large	63.4	61.8	59.2	58.5	50.0	50.3	50.1	48.4	47.3	46.0
Hospital region, %											0.76
Northeast	22.9	21.3	21.2	20.5	19.7	19.1	18.6	18.8	18.6	19.1
Midwest	25.3	24.9	24.6	24.5	24.1	23.9	23.7	24.7	24.5	24.6
South	35.9	36.8	36.8	38.4	38.9	39.8	39.6	39.6	40.3	39.7
West	15.9	17.0	17.4	16.7	17.3	17.2	18.1	16.9	16.5	16.6
Location/teaching status of hospital, %											< 0.001
Rural	12.3	12.9	12.3	12.7	10.3	10.9	11.1	11.3	11.5	11.3
Urban nonteaching	47.5	45.7	42.6	41.8	30.4	31.1	30.1	26.3	23.2	21.7
Urban teaching	40.3	41.4	45.1	45.4	59.3	58.0	58.9	62.4	65.3	67.0

Table 3. Biodemographic Data of Hospitalizations With Principal Admitting Diagnosis of CDI

Variable

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

P-value

CCI: Charlson comorbidity index; CDI: Clostridioides difficile infection; MHOI: median household income national quartile for patient ZIP code; SD: standard deviation from the mean.

Total principal admissions for CDI

103,845

116,138

115,830

107,730

104,695

106,905

103,135

93,810

86,285

76,325

CDI admission rate, per 100,000 hospitalizations

331

369

377

359

351

354

342

309

285

253

Mean age ± SD, years

69.4 ± 17.5

69.2 ± 18.0

67.9 ± 17.5

67.3 ± 17.7

66.4 ± 17.8

65.9 ± 17.9

65.8 ± 17.7

66.1 ± 17.5

66.5 ± 17.2

66.6 ± 16.9

< 0.001

Age categories, %

< 0.001

Young adults

10.0

10.5

11.8

12.6

13.4

14.0

13.7

13.1

12.4

12.2

Middle aged

23.7

23.4

24.5

25.8

26.9

27.4

27.9

27.5

Elderly

66.3

66.1

63.7

61.7

59.7

58.6

58.5

59.0

60.1

60.3

Female, %

64.3

65.8

65.3

65.1

65.5

64.8

65.1

64.2

64.4

63.9

0.002

Race, %

< 0.001

White

71.2

71.5

75.2

74.8

75.0

75.2

75.8

75.9

75.8

Black

8.9

9.2

9.6

9.8

10.1

10.7

10.3

10.4

10.6

11.0

Hispanic

5.9

7.1

6.8

7.2

6.9

7.5

7.8

7.5

Others

14.0

12.2

8.4

8.3

7.9

7.4

7.0

6.3

5.8

5.7

CCI score, %

< 0.001

31.7

31.3

32.0

32.8

32.1

33.2

26.8

25.9

24.5

22.1

21.8

20.8

20.4

21.3

20.3

21.0

20.5

19.9

19.5

17.8

17.9

17.6

17.2

16.3

16.1

17.0

17.1

17.2

16.7

≥ 3

28.4

29.1

29.6

30.4

30.5

35.2

36.6

38.4

39.3

Primary payer, %

< 0.001

Medicare

70.5

71.1

70.5

68.5

67.3

66.0

66.2

66.9

68.4

66.8

Medicaid

7.1

7.3

7.9

8.1

10.8

11.0

11.6

10.9

10.4

Private insurance

20.0

19.1

18.8

20.2

19.6

20.8

20.0

19.8

18.8

20.1

No insurance

2.5

2.9

3.2

2.3

2.1

2.3

2.4

2.7

MHOI quartile, %

< 0.001

23.9

25.4

26.9

28.6

27.9

27.8

27.2

27.8

26.1

24.2

24.5

27.0

28.0

25.5

27.0

27.7

28.3

26.5

25.7

26.5

25.2

24.8

24.2

25.0

24.7

23.8

24.7

24.6

24.4

23.9

23.5

21.3

20.8

20.9

20.4

20.8

19.9

21.1

Hospital bed-size, %

< 0.001

Small

12.3

13.0

15.1

15.0

19.8

19.5

20.8

21.4

23.1

24.4

Medium

24.3

25.2

25.8

26.6

30.1

30.2

29.1

30.2

29.7

29.6

Large

63.4

61.8

59.2

58.5

50.0

50.3

50.1

48.4

47.3

46.0

Hospital region, %

0.76

Northeast

22.9

21.3

21.2

20.5

19.7

19.1

18.6

18.8

18.6

19.1

Midwest

25.3

24.9

24.6

24.5

24.1

23.9

23.7

24.7

24.5

24.6

South

35.9

36.8

38.4

38.9

39.8

39.6

40.3

39.7

West

15.9

17.0

17.4

16.7

17.3

17.2

18.1

16.9

16.5

16.6

Location/teaching status of hospital, %

< 0.001

Rural

12.3

12.9

12.3

12.7

10.3

10.9

11.1

11.3

11.5

11.3

Urban nonteaching

47.5

45.7

42.6

41.8

30.4

31.1

30.1

26.3

23.2

21.7

Urban teaching

40.3

41.4

45.1

45.4

59.3

58.0

58.9

62.4

65.3

67.0

**Table 4.** Outcomes of Hospitalizations With Principal Admitting Diagnosis of CDI
Variable	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	P-value
LOS: length of hospital stay; MHOI: median household income national quartile for patient ZIP code; THC: total hospital charges.
Mortality rate, %	3.2	2.7	2.3	2.1	1.7	1.5	1.3	1.4	1.2	1.4	< 0.001
Mean LOS, days	6.6	6.3	6.1	6.0	5.8	5.6	5.5	5.4	5.4	5.3	< 0.001
Mean THC, US$	40,593	41,035	39,855	39,975	39,015	38,587	39,981	40,313	41,104	42,934	< 0.001
Mortality rate among females, %	3.1	2.5	2.1	2.0	1.7	1.3	1.2	1.2	1.0	1.2	< 0.001
Mean LOS among females, days	6.5	6.2	6.1	5.9	5.8	5.5	5.5	5.3	5.3	5.3	< 0.001
Mean THC among females, US$	38,966	39,259	39,073	38,867	38,331	38,018	39,246	38,873	40,153	41,527	< 0.001
Mortality rate among males, %	3.4	3.1	2.6	2.3	1.8	1.9	1.6	1.6	1.5	1.8	< 0.001
Mean LOS among males, days	6.9	6.5	6.1	6.0	5.9	5.6	5.6	5.6	5.4	5.5	< 0.001
Mean THC among males, US$	43,526	44,453	41,331	42,050	40,318	39,634	41,355	42,894	42,822	45,421	< 0.001
Mortality rate among Whites, %	3.4	2.9	2.4	2.1	1.8	1.6	1.4	1.4	1.3	1.4	< 0.001
Mean LOS among Whites, days	6.6	6.3	6.1	5.9	5.7	5.5	5.5	5.3	5.3	5.2	< 0.001
Mean THC among Whites, US$	39,861	39,694	38,553	37,984	37,559	36,737	38,036	37,878	39,079	40,739	< 0.001
Mortality rate among Blacks, %	2.8	2.4	1.9	1.9	1.4	1.1	1.1	1.0	0.7	1.3	< 0.001
Mean LOS among Blacks, days	7.5	7.1	6.5	6.4	6.4	6.1	5.9	6.0	5.9	5.8	< 0.001
Mean THC among Blacks, US$	46,705	49,212	43,996	42,940	43,114	42,634	45,342	47,192	46,100	45,873	< 0.001
Mortality rate among Hispanics, %	2.3	2.3	1.2	2.3	1.5	1.1	1.3	1.0	0.9	2.0	0.002
Mean LOS among Hispanics, days	6.9	6.5	6.4	6.1	6.0	5.6	5.8	5.3	5.3	5.4	< 0.001
Mean THC among Hispanics, US$	55,307	56,655	53,541	56,429	51,889	50,918	52,029	52,115	53,860	57,604	< 0.001
Mortality rate among MHOI quartile 1, %	3.4	2.8	2.2	2.2	1.6	1.5	1.5	1.6	1.1	1.5	< 0.001
Mean LOS among MHOI quartile 1, days	6.7	6.4	6.1	6.0	5.9	5.6	5.7	5.6	5.5	5.4	< 0.001
Mean THC among MHOI quartile 1, US$	37,409	38,967	37,114	39,224	38,616	37,799	39,635	49,742	39,250	40,536	< 0.001
Mortality rate among MHOI quartile 4, %	3.6	2.5	2.2	1.9	1.6	1.6	1.2	1.5	1.3	1.5	< 0.001
Mean LOS among MHOI quartile 4, days	6.8	6.4	6.2	5.9	5.9	5.5	5.5	5.4	5.4	5.3	< 0.001
Mean THC among MHOI quartile 4, US$	45,677	42,582	44,961	44,014	43,551	42,678	44,947	44,702	46,938	47,737	< 0.001

Table 4. Outcomes of Hospitalizations With Principal Admitting Diagnosis of CDI

Variable

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

P-value

LOS: length of hospital stay; MHOI: median household income national quartile for patient ZIP code; THC: total hospital charges.

Mortality rate, %

3.2

2.7

2.3

2.1

1.7

1.5

1.3

1.4

1.2

1.4

< 0.001

Mean LOS, days

6.6

6.3

6.1

6.0

5.8

5.6

5.5

5.4

5.3

< 0.001

Mean THC, US$

40,593

41,035

39,855

39,975

39,015

38,587

39,981

40,313

41,104

42,934

< 0.001

Mortality rate among females, %

3.1

2.5

2.1

2.0

1.7

1.3

1.2

1.0

1.2

< 0.001

Mean LOS among females, days

6.5

6.2

6.1

5.9

5.8

5.5

5.3

< 0.001

Mean THC among females, US$

38,966

39,259

39,073

38,867

38,331

38,018

39,246

38,873

40,153

41,527

< 0.001

Mortality rate among males, %

3.4

3.1

2.6

2.3

1.8

1.9

1.6

1.5

1.8

< 0.001

Mean LOS among males, days

6.9

6.5

6.1

6.0

5.9

5.6

5.4

5.5

< 0.001

Mean THC among males, US$

43,526

44,453

41,331

42,050

40,318

39,634

41,355

42,894

42,822

45,421

< 0.001

Mortality rate among Whites, %

3.4

2.9

2.4

2.1

1.8

1.6

1.4

1.3

1.4

< 0.001

Mean LOS among Whites, days

6.6

6.3

6.1

5.9

5.7

5.5

5.3

5.2

< 0.001

Mean THC among Whites, US$

39,861

39,694

38,553

37,984

37,559

36,737

38,036

37,878

39,079

40,739

< 0.001

Mortality rate among Blacks, %

2.8

2.4

1.9

1.4

1.1

1.0

0.7

1.3

< 0.001

Mean LOS among Blacks, days

7.5

7.1

6.5

6.4

6.1

5.9

6.0

5.9

5.8

< 0.001

Mean THC among Blacks, US$

46,705

49,212

43,996

42,940

43,114

42,634

45,342

47,192

46,100

45,873

< 0.001

Mortality rate among Hispanics, %

2.3

1.2

2.3

1.5

1.1

1.3

1.0

0.9

2.0

0.002

Mean LOS among Hispanics, days

6.9

6.5

6.4

6.1

6.0

5.6

5.8

5.3

5.4

< 0.001

Mean THC among Hispanics, US$

55,307

56,655

53,541

56,429

51,889

50,918

52,029

52,115

53,860

57,604

< 0.001

Mortality rate among MHOI quartile 1, %

3.4

2.8

2.2

1.6

1.5

1.6

1.1

1.5

< 0.001

Mean LOS among MHOI quartile 1, days

6.7

6.4

6.1

6.0

5.9

5.6

5.7

5.6

5.5

5.4

< 0.001

Mean THC among MHOI quartile 1, US$

37,409

38,967

37,114

39,224

38,616

37,799

39,635

49,742

39,250

40,536

< 0.001

Mortality rate among MHOI quartile 4, %

3.6

2.5

2.2

1.9

1.6

1.2

1.5

1.3

1.5

< 0.001

Mean LOS among MHOI quartile 4, days

6.8

6.4

6.2

5.9

5.5

5.4

5.3

< 0.001

Mean THC among MHOI quartile 4, US$

45,677

42,582

44,961

44,014

43,551

42,678

44,947

44,702

46,938

47,737

< 0.001