Leveraging multi-database linkages to assess racial and ethnic disparities among Carbapenem-resistant Enterobacterales cases in Tennessee, 2015-2019.

Background: Awareness of health disparities' impact on clinical outcomes is increasing. However, public health's ability to highlight these trends can be limited by data missingness, such as on race and ethnicity. To better understand race and ethnicity's impact, we compared all-cause 30-day mortality rates between non-Hispanic (NH) Black, NH White, and Hispanic/NH other racial and ethnic patients among cases of carbapenem-resistant Enterobacterales (CRE).

Methods: We performed data linkage using CRE statewide surveillance, Hospital Discharge Data System, and vital records data to obtain demographics and clinical outcomes on CRE cases in TN. We evaluated the association between race and ethnicity with all-cause 30-day mortality among CRE cases.

Results: Among 2,804 reported CRE cases from 2015 to 2019, 65% (n = 1,832) were missing race and ethnicity; data linkage methods reduced missingness to 10% (n = 285). 22%, 74%, and 3% of cases were among NH Black, NH White, and Hispanic/NH other patients, respectively. Thirty-day all-cause mortality among NH Black patients was 5.7 per 100,000 population, 1.9 and 5.7 times higher than NH White and Hispanic/NH other patients. We observed that the risk of dying within 30 days of CRE diagnosis was 35% higher for NH Black compared to NH White patients; unmeasured confounders may be present (adjusted risk ratio 1.35; 95% CI 1.00, 1.83).

Conclusion: Data linkage effectively reduced missingness of race and ethnicity. Among those with CRE, NH Blacks may have an increased risk of all-cause 30-day mortality. Data missingness creates barriers in identifying health disparities; data linkage is one approach to overcome this challenge.