Perhaps because they have better access to healthcare and, therefore, are likely to take more antibiotics, white people have higher mortality rates from Clostridioides difficile infections (CDIs) than those who are Black or Hispanic, according to a study presented at IDWeek 2025, in Atlanta.
In addition, women and those who live in large metropolitan areas were also likely to have higher mortality rates from CDIs than men or people who live in less populated areas, according to Muhammad Sohaib Asghar, MBBS, MD, a resident physician at AdventHealth Sebring, in Florida, and presenting author of the study (abstract 193).
Related Content
CDI Demographics
Dr. Asghar and his colleagues reviewed 25 years of data from the CDC WONDER database to compare the demographics of people with CDIs and to see how the infections changed over that period. They included patients who died in the inpatient or outpatient setting that listed an ICD-10 code for C. difficile enterocolitis as a contributory cause of the death, he explained.
“As we know, it [CDI] remains a significant public health concern in the United States,” Dr. Asghar said at a press briefing before IDWeek. “It does contribute to a significant amount of mortality and morbidity especially among the hospitalized patients and the other elderly age groups.”
The researchers found that white people accounted for 83.9% of C. difficile–related deaths, while Black individuals made up 8.1%, Hispanic people accounted for 5.5%, and Alaska Native, Asian, and Pacific Islander patients accounted for 2.2%, according to a review of 216,311 deaths due to C. difficile in the United States, which occurred between 1999 and 2023, according to Dr. Asghar.
When looking at gender, Dr. Asghar found that C. difficile death rates were higher for women than men, with women accounting for 58.2% of deaths.
The study also revealed stark geographic differences in deaths caused by CDIs. More than 83.8% of deaths occurred in and around metropolitan areas across the country.
Data show that people in healthcare settings were especially susceptible: 71.2% of deaths occurred in inpatient settings, with another 21.2% in a nursing or long-term care facility, outpatient, ER setting, or hospice facility.
Unexpected Results
Dr. Asghar said the results surprised him. “When we talk about social determinants of health, we expect people who are getting infected or dying from these infections are usually from low socioeconomic or those people who have lesser access to healthcare utilization. However, in C. diff it’s actually opposite,” he said.
“It’s the white population. They have more resources, they have more access to healthcare utilization, and these are more prone to maybe being exposed to antibiotics,” he said.
“This was the most striking finding of the study: that the disease itself is more prone to those who have more access to healthcare. And this really surprised me when I was studying this.”
A Decline in Mortality
However, U.S. C. diff deaths peaked between 2006 and 2015, and then started to fall, Dr. Asghar explained at a press briefing before the conference. “In terms of the decline post-2016, almost all regions have shown a similar amount of decline. And part of this is due to having more readily available therapies, such as fidaxomicin (Dificid, Merck), which is now the first-line therapy,” he said, as well as fecal microbiota therapies, which are more recently approved therapies.
He added that the growing threat of antimicrobial resistance may have also played a role, as more institutes are practicing antimicrobial stewardship.
“The decline in the mortality rate is mostly attributed to improve infection control practices and antimicrobial stewardship programs. Obviously, the irrational use of antibiotics has been one of the risk factors most associated with C. difficile infection,” Dr. Asghar said.
He noted that those types of programs, as well as raising awareness of preventive measures like hand hygiene, could help lower rates even further.