Hospitals that see fewer minority patients have experienced a downward trend in ICU deaths during the past decade, but the same has not been true for hospitals with larger minority populations, researchers reported in the American Journal of Respiratory and Critical Care Medicine.
For the study, John Danziger, MD, DPhil, assistant professor of medicine at Harvard Medical School and physician at Beth Israel Deaconess Medical Center, and colleagues charted trends in critical care outcomes over time for minority-serving hospitals or nonminority-serving hospitals.
“We wanted to know whether racial inequalities, previously described across a range of health care environments, extend into the highest level of care, namely the ICU,” Danziger said in a press release.
The researchers used the Philips Healthcare eICU Research Institute Database to glean information on ICU outcomes at more than 300 hospitals in the United States. Census data were also used to identify minority-serving hospitals, which were defined as hospitals with twice as many black or Hispanic patients as expected based on the percentage of those living in the region or as hospitals in which more than 25% of the ICU patients were black or Hispanic.
Of the nearly 1.1 million critically ill patients included in the analysis, 25% of black patients and 48% of Hispanic patients, as compared with 5.2% of white patients, were treated at one of 14 minority-serving hospitals from 2006 to 2016.
Results showed that during 10 years, critical illness mortality decreased by 2% per year in nonminority-serving hospitals but not in minority-serving hospitals. The difference in mortality was particularly pronounced among black patients, according to the researchers. Specifically, black patients treated at nonminority-serving hospitals experienced a 3% decrease in critical illness mortality each year vs. no change for those treated at minority-serving hospitals.
Additionally, ICU and hospital lengths of stay decreased steadily by 0.8 and 0.16 days each year, respectively, in nonminority-serving hospitals, the declines were significantly less among minority-serving hospitals and were “essentially constant” from 2011 to 2016, the researchers noted. Again, the disparity in improvement was most notable among black patients.
Patients treated at minority-serving hospitals tended to be younger and have a lower burden of disease in terms of comorbidities but higher severity of illness and mortality. The researchers also found that wait times from admission to the ICU from the ED were longer for patients treated at minority-serving hospitals vs. nonminority-serving hospitals.
“Accordingly, it is difficult to determine whether our findings reflect caring for an increasingly disadvantaged population or differences in hospital resource utilization,” the researchers wrote.
“The observation that large numbers of critically ill minorities are cared for in
poorer performing ICUs gives us an important target for focused research efforts and additional resources to help close the health care divide among different minorities in the United States,” Danziger said in the release. – by Melissa Foster
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