PDF(Pubmed)
Abstract：
Community-acquired Staphylococcus aureus (CA-Sa) skin and soft tissue infections (SSTIs) are historically associated with densely populated urban areas experiencing high poverty rates, intravenous drug use, and homelessness. However, the epidemiology of CA-Sa SSTIs in the United States has been poorly understood since the plateau of the Community-acquired Methicillin-resistant Staphylococcus aureus epidemic in 2010. This study examines the spatial variation of CA-Sa SSTIs in a large, geographically heterogeneous population and identifies neighborhood characteristics associated with increased infection risk.
Using a unique neighborhood boundary, California Medical Service Study Areas, a hotspot analysis, and estimates of neighborhood infection risk ratios were conducted for all CA-Sa SSTIs presented in non-Federal California emergency departments between 2016 and 2019. A Bayesian Poisson regression model evaluated the association between neighborhood-level infection risk and population structure, neighborhood poverty rates, and being a healthcare shortage area.
Emergency departments in more rural and mountainous parts of California experienced a higher burden of CA-Sa SSTIs between 2016 and 2019. Neighborhoods with high infection rates were more likely to have a high percentage of adults living below the federal poverty level and be a designated healthcare shortage area. Measures of population structure were not associated with infection risk in California neighborhoods.
Our results highlight a potential change in the epidemiology of CA-Sa SSTIs in California emergency departments. Future studies should investigate the CA-Sa burden in other geographies to identify whether this shift in epidemiology holds across other states and populations. Further, a more thorough evaluation of potential mechanisms for the clustering of infections seen across California neighborhoods is needed.
Using a unique neighborhood boundary, California Medical Service Study Areas, a hotspot analysis, and estimates of neighborhood infection risk ratios were conducted for all CA-Sa SSTIs presented in non-Federal California emergency departments between 2016 and 2019. A Bayesian Poisson regression model evaluated the association between neighborhood-level infection risk and population structure, neighborhood poverty rates, and being a healthcare shortage area.
Emergency departments in more rural and mountainous parts of California experienced a higher burden of CA-Sa SSTIs between 2016 and 2019. Neighborhoods with high infection rates were more likely to have a high percentage of adults living below the federal poverty level and be a designated healthcare shortage area. Measures of population structure were not associated with infection risk in California neighborhoods.
Our results highlight a potential change in the epidemiology of CA-Sa SSTIs in California emergency departments. Future studies should investigate the CA-Sa burden in other geographies to identify whether this shift in epidemiology holds across other states and populations. Further, a more thorough evaluation of potential mechanisms for the clustering of infections seen across California neighborhoods is needed.
摘要：
背景：社区获得性金黄色葡萄球菌（CA-Sa）皮肤和软组织感染（STTI）与人口稠密的城市地区经历高贫困率相关，静脉注射毒品,和无家可归。然而,自2010年社区获得性耐甲氧西林金黄色葡萄球菌流行以来,美国对CA-SaSTTI的流行病学了解甚少。本研究考察了CA-SaSSTI在大型、地理异质性人群，并确定与感染风险增加相关的邻里特征。
方法：使用唯一的邻域边界，加州医疗服务研究区，热点分析，我们对2016年至2019年在非联邦加州急诊科提交的所有CA-SaSTTI进行了邻里感染风险比估算.贝叶斯泊松回归模型评估了邻域水平感染风险与人口结构之间的关系，邻里贫困率，成为医疗保健短缺的地区。
结果：在2016年至2019年期间，加利福尼亚州更多农村和山区的急诊科经历了更高的CA-SaSTTI负担。感染率高的社区更有可能有较高比例的成年人生活在联邦贫困水平以下，并且是指定的医疗保健短缺地区。在加利福尼亚社区，人口结构的测量与感染风险无关。
结论：我们的研究结果强调了加州急诊科CA-SaSSTI流行病学的潜在变化。未来的研究应该调查其他地区的CA-Sa负担，以确定流行病学的这种转变是否在其他州和人群中存在。Further,我们需要对加州各社区感染聚集的潜在机制进行更全面的评估.
方法：使用唯一的邻域边界，加州医疗服务研究区，热点分析，我们对2016年至2019年在非联邦加州急诊科提交的所有CA-SaSTTI进行了邻里感染风险比估算.贝叶斯泊松回归模型评估了邻域水平感染风险与人口结构之间的关系，邻里贫困率，成为医疗保健短缺的地区。
结果：在2016年至2019年期间，加利福尼亚州更多农村和山区的急诊科经历了更高的CA-SaSTTI负担。感染率高的社区更有可能有较高比例的成年人生活在联邦贫困水平以下，并且是指定的医疗保健短缺地区。在加利福尼亚社区，人口结构的测量与感染风险无关。
结论：我们的研究结果强调了加州急诊科CA-SaSSTI流行病学的潜在变化。未来的研究应该调查其他地区的CA-Sa负担，以确定流行病学的这种转变是否在其他州和人群中存在。Further,我们需要对加州各社区感染聚集的潜在机制进行更全面的评估.
