A population-based matched cohort study examining the mortality and costs of patients with community-onset Clostridium difficile infection identified using emergency department visits and hospital admissions

PLoS One. 2017 Mar 3;12(3):e0172410. doi: 10.1371/journal.pone.0172410. eCollection 2017.


Few studies have evaluated the mortality or quantified the economic burden of community-onset Clostridium difficile infection (CDI). We estimated the attributable mortality and costs of community-onset CDI. We conducted a population-based matched cohort study. We identified incident subjects with community-onset CDI using health administrative data (emergency department visits and hospital admissions) in Ontario, Canada between January 1, 2003 and December 31, 2010. We propensity-score matched each infected subject to one uninfected subject and followed subjects in the cohort until December 31, 2011. We evaluated all-cause mortality and costs (unadjusted and adjusted for survival) from the healthcare payer perspective (2014 Canadian dollars). During our study period, we identified 7,950 infected subjects. The mean age was 63.5 years (standard deviation = 22.0), 62.7% were female, and 45.0% were very high users of the healthcare system. The relative risk for 30-day, 180-day, and 1-year mortality were 7.32 (95% confidence interval [CI], 5.94-9.02), 3.55 (95%CI, 3.17-3.97), and 2.59 (95%CI, 2.37-2.83), respectively. Mean attributable cumulative 30-day, 180-day, and 1-year costs (unadjusted for survival) were $7,434 (95%CI, $7,122-$7,762), $12,517 (95%CI, $11,687-$13,366), and $13,217 (95%CI, $12,062-$14,388). Mean attributable cumulative 1-, 2-, and 3-year costs (adjusted for survival) were $10,700 (95%CI, $9,811-$11,645), $13,312 (95%CI, $12,024-$14,682), and $15,812 (95%CI, $14,159-$17,571). Infected subjects had considerably higher risk of all-cause mortality and costs compared with uninfected subjects. This study provides insight on an understudied patient group. Our study findings will facilitate assessment of interventions to prevent community-onset CDI.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Canada / epidemiology
  • Child
  • Clostridioides difficile / pathogenicity*
  • Clostridium Infections / economics
  • Clostridium Infections / microbiology
  • Clostridium Infections / mortality*
  • Clostridium Infections / physiopathology
  • Cohort Studies
  • Costs and Cost Analysis / economics
  • Cross Infection / economics
  • Cross Infection / microbiology
  • Cross Infection / mortality*
  • Cross Infection / physiopathology
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospitalization / economics
  • Humans
  • Length of Stay / economics
  • Male
  • Middle Aged

Grant support

This study was supported by a CIHR operating grant (grant number: MOP 130553, grant recipient: Beate Sander), the Institute for Clinical Evaluative Sciences (ICES), and Public Health Ontario (PHO). ICES and PHO are funded by annual grants from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this article do not necessarily represent the views of CIHR, ICES, PHO, or the MOHLTC. Parts of this material are based on data and information compiled and provided by the Canadian Institute of Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of CIHI.