Year: 2021
Type: conference-abstract
Abstract: Introduction: Intensive care unit (ICU) admission is thought to be directed by severity of illness and goals of care of patients. Some researchers have suggested that ICU admission may differ by gender, even after adjustment for illness severity. However, it remains unclear whether there are differences in access to ICU care by race/ethnicity. The aim of this study was to describe the demographic characteristics and comorbidities of patients admitted to the ICU and to assess the association between race and ethnicity and admission to ICU services among hospitalized patients. Methods: We retrieved hospital discharge data from the Agency for Healthcare Research and Quality-sponsored Statewide Inpatient Database for Florida in 2017. The primary outcome of interest was ICU admission. The primary exposures of interest were race (White, Black, Other) and Hispanic ethnicity. Demographic covariates included age, gender, household income for patient zip code, insurance status, and homelessness. We also controlled for comorbidity using the Elixhauser comorbidity index. Means and standard deviations or n and frequencies were used to describe all variables. An unadjusted model assessed the association between race and ethnicity and ICU admission using log binomial regression with generalized estimating equations to account for clustering of patients within hospitals, and an adjusted model further controlled for demographic and comorbidity covariates. Results: Of the 1,549,331 patients included in the study, 76% were White, 18% were Black, and 16% were Hispanic. There were 540,103 discharges involving ICU admission (35%). When compared to discharges not involving ICU stay, discharges involving ICU admissions had a higher proportion of patients older than 65 years (58% vs 47%). There were slightly more males (51% vs. 49%), and there were more patients with insurance (88% vs. 85%). The prevalence of almost all comorbidities was higher among patients admitted to the ICU compared with patients not admitted to the ICU. The prevalence of ICU admission was lower among Hispanic patients after adjusting for race (prevalence ratio: 0.93; 95% CI: 0.93-0.94) and this effect persisted even after controlling for other demographic characteristics and comorbidities (adjusted prevalence ratio: 0.98; 95% CI: 0.97-0.99). Conclusions: Among hospitalized patients, Hispanic patients are slightly less likely to be admitted to the ICU compared with non-Hispanic patients even after accounting for differences in demographic characteristics and comorbidities. Further evaluation is needed to identify reasons for disparate ICU admission, including patient preference, illness severity at presentation, and physician bias.
Authors: P. Cheung, M.R. Kramer, J.A. Kempker
Institutions: Emory University, Emory Healthcare
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4231583297