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The following is a summary of “Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study,” published in the April 2024 issue of Critical Care by Benaïs et al.
Although socioeconomic factors are known to worsen health outcomes, their impact on critically ill patients is poorly understood due to varying definitions used in past research.
Researchers conducted a retrospective study investigating the association between socioeconomic deprivation and outcomes in critical care patients.
They enrolled all adult patients (≥18 years) admitted to 8 ICUs in the Greater Paris area (March to June 2018). Socioeconomic status was categorized using hierarchical clustering based on education, health insurance, income, and housing data. The association between these socioeconomic phenotypes and 180-day mortality was analyzed using Cox proportional hazards models.
The result showed 1,748 patients with a median age of 62.9 years, within the range of 47.4 to 74.5 years. Among the participants, 654 (37.4%) were female, and the median SOFA score was 3, ranging from 1 to 6. The population was divided into five phenotypes, each representing a different level of socioeconomic deprivation. The Phenotype A patients (n = 958/1,748, 54.8%) did not experience any socioeconomic deprivation, Phenotype B patients (n = 273/1,748, 15.6%) only had lower education levels, Phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1 [1-2] deprivations and were all housing deprivation, Phenotype D patients (n = 93/1,748, 5.3%) included patients with 3 [2-4] deprivations and patients without health insurance deprivation. With a majority of housing deprivation, the patients from phenotypic C were more likely to be diagnosed with chronic respiratory diseases upon admission and received more non-invasive positive pressure ventilation. After adjusting for age, sex, alcohol, and opiate use, socioeconomic phenotypes were not found to be associated with increased 180-day mortality: phenotype A served as the reference group; phenotype B had an HR of 0.85 (95% CI 0.65–1.12); phenotype C had an HR of 0.56 (95% CI 0.34–0.93); phenotype D had an HR of 1.09 (95% CI 0.78–1.51); and phenotype E had an HR of 1.20 (95% CI 0.73–1.96).
Investigators concluded that even in universal healthcare, socioeconomic disadvantage wasn’t linked to higher short-term death rates. However, disadvantaged groups have unique health issues requiring focused public health efforts.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01279-1