Key result
Living in a low-income neighborhood was associated with an increased risk of community-associated MRSA infection compared to high-income neighborhoods.
Why the study?
The impact of neighborhood-level income on community-associated MRSA risk remains poorly understood, with conflicting findings and no known US-based systematic reviews.
Does living in a low-income neighborhood increase the risk of CA-MRSA infection in the US population?
Meta-Analysis
Does living in a low-income neighborhood increase the risk of CA-MRSA infection in the US population?
Living in a low-income neighborhood is associated with a 28% increased odds of CA-MRSA infection compared to high-income neighborhoods, though this association loses significance when restricted to low risk of bias studies.
Answers are grounded in this paper and cite their sources.
Association not robust to bias adjustment; leaves open whether neighborhood income independently predicts CA-MRSA risk.
BACKGROUND: The impact of neighborhood-level income on community-associated methicillin-resistant S. aureus (CA-MRSA) risk remains poorly understood, despite established associations between MRSA risk and the social determinants of health. There are conflicting findings in the existing literature and no known systematic reviews based in the U.S. Our objective was to conduct a systematic review and meta-analysis of the association between neighborhood-level income and CA-MRSA in the U.S. METHODS: We searched MEDLINE (Ovid), MEDLINE Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, and Daily (Ovid), Global Health (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews (Wiley), Cochrane Central Register of Controlled Trials (Wiley), and Web of Science Core Collection from 2017 to 10 January 2021. An updated search was completed in November 2023. Eligible studies reported stratified CA-MRSA case counts and/or effect measures by neighborhood income level, reported as a categorical or continuous variable. Relevant data were extracted using Covidence following the PRISMA guidelines. A random-effects model meta-analysis was used to estimate the pooled effect measure. Three study design-specific risk of bias assessments and a quality assessment were applied using the modified Newcastle-Ottawa Quality Assessment Scale and GRADE approach, respectively. RESULTS: 73%). Limiting to low risk of bias studies (n = 3), there was no significant relationship between low income and CA-MRSA infection (OR: 1.13, 95% CI: 0.96, 1.33) with heterogeneity of 0%. CONCLUSIONS: Evidence supports an association between lower neighborhood income and higher CA-MRSA infection risk, albeit with considerable heterogeneity. Future studies should consider evaluating neighborhood-level income as a continuous variable, and at the block-group level to avoid exposure misclassification. Furthermore, researchers should consider adjusting for covariates that could allow for a causal interpretation of the relationship between low neighborhood-level income and CA-MRSA risk.
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Blackmon et al. (2025) conducted a meta-analysis in Community-associated methicillin-resistant S. aureus (CA-MRSA) infection. Living in a low-income neighborhood vs. Living in a high-income neighborhood was evaluated on CA-MRSA infection (OR 1.28, 95% CI 1.13, 1.46). Living in a low-income neighborhood was associated with an increased risk of community-associated MRSA infection compared to high-income neighborhoods.
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