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Open Access Research article

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

Amanda M Farr12*, Melissa A Marx34, Don Weiss3 and Denis Nash15

Author affiliations

1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

2 Current affiliation: Custom Data Analytics, Truven Health Analytics, Washington, DC, USA

3 Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, NY, USA

4 Current affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Lukasa, Zambia

5 Current affiliation: Epidemiology and Biostatistics Program, CUNY School of Public Health at Hunter College, New York, NY, USA

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Citation and License

BMC Infectious Diseases 2013, 13:84  doi:10.1186/1471-2334-13-84

Published: 13 February 2013

Abstract

Background

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.

Methods

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.

Results

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: AORQ4 vs. Q1 1.7, 95% CI: 1.1, 2.7; females: AORQ4 vs. Q1 2.0, 95% CI: 1.1, 3.6); but this association did not hold for neighborhoods in the highest quintile (males: AORQ5 vs. Q1 1.2, 95% CI: 0.76, 1.8; females: AORQ5 vs. Q1 1.5, 95% CI: 0.82, 2.7).

Conclusions

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.

Keywords:
Antibiotic resistance; Hospitalizations; Multilevel analysis