Jacinda Abdul-Mutakabbir, PharmD, MPH, and her colleagues were looking at a study on multidrug-resistant extended-spectrum beta-lactamases (ESBLs), and how rapid diagnostic tools could be influential in this area of research. ESBLs are enzymes that bacteria can produce, and which destroy common antibiotics.
They discovered a glaring inequity: Black patients in the study were far more likely to be diagnosed with ESBL infections than white patients. They were also more likely to have chronic comorbidities and other problems that would exacerbate infection.
Raised in Detroit, where 70% of residents are Black, Abdul-Mutakabbir took these findings to heart.
“When I looked at that study, I think it became personal to me,” said Abdul-Mutakabbir, an assistant professor of clinical pharmacy at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.
Whenever she does research, she thinks about it in the context of decreasing resistance for people who look like her.
In an episode of the “Stories of Care” podcast, Abdul-Mutakabbir joined infectious diseases physician Megan Srinivas, MD, MPH, to discuss the importance of promoting research on racial inequities in health care-associated infections. “Stories of Care” is sponsored by AMA and the Centers for Disease Control and Prevention’s (CDC) Project Firstline, a national training collaborative for infection prevention and control.
C. diff and kidney disease
Properly understanding the social drivers of health can offer clues as to why Black patients are more likely to suffer from infection. These include inequities in health literacy, housing and health insurance coverage.
Abdul-Mutakabbir took a closer look at Clostridioides difficile to make these connections between infectious diseases and racial inequities.
“When we think about infectious diseases, the first place that you start, of course, is C. diff, right? We know that we're doing a good job or we know that we're doing a bad job if we have high C. diff rates,” she said. Working with resident Jina Lee, MD, Abdul-Mutakabbir focused her research on Loma Linda, California, a populous county with a high representation of Blacks and Hispanics, to do her research.
Patients from historically marginalized racial and ethnic groups in the study weren’t just more likely to have C. diff—they had higher rates of severe and fulminant C. diff infections.
A number of patients also had chronic comorbidities such as diabetes or chronic kidney disease. Abdul-Mutakabbir and colleagues did a counterfactual mediation analysis and found that chronic kidney disease or preexisting diagnoses contributed to about 10% of the potential risk in a patient developing a severe or fulminant infection with C. diff.
When it comes to patients from historically marginalized racial and ethnic groups, it’s clear that physicians should watch them for C. diff, she emphasized.
Candida research yields similar patterns
In other research, Abdul-Mutakabbir and colleagues identified a similar link between patients from historically marginalized racial and ethnic groups and Candida infections. Just as with C. diff, these patients were more likely to have chronic comorbidities such as diabetes.
Digging deeper, she noticed an inequity in Candida strains—that Candida glabrata was more likely to appear in white patients, whereas Candida parapsilosis predominated in patients from historically marginalized racial and ethnic groups.
Total parenteral nutrition placement or some type of environmental exposure might explain the difference, or the fact that the patients from historically marginalized racial and ethnic groups were sicker than the other cohort, she speculated.
In science, it’s very easy to use statistics to explain away the “why” of something. Instead, researchers should be thinking about causality and not taking the numbers at face value, said Abdul-Mutakabbir.
Using a tool of CDC’s, she has started to look at “social vulnerability” as a risk factor and potential adjunct to chronic comorbidities. Social vulnerability, the CDC explains, “refers to the potential negative effects on communities caused by external stresses on human health.” These include “natural or human-caused disasters or disease outbreaks.”
Learn more with the AMA Ed Hub™ Health Equity Education Center, which offers a broad array of CME activities to help physicians and other health professionals confront health injustice and advance equity.
