No abstract

We created a risk score that classifies patients with ILD with acute respiratory failure from low to high risk for in-hospital mortality. The score could aid providers in counseling these patients and their families.

Objective To determine whether minority race or ethnicity are associated with mortality and mediated by health insurance coverage among older (age ≥65 years) survivors of critical illness. Design A retrospective cohort study. Setting Two New York City academic medical centers. Patients A total of 1,947 consecutive white (1,107), black (361), and Hispanic (479) older adults who had their first medical-ICU admission from 2006 through 2009 and survived to hospital discharge. Interventions None. Measurements and Main Results We obtained demographic, insurance, and clinical data from electronic health records, determined each patient’s neighborhood-level socioeconomic data from 2010 US Census tract data, and determined death dates using the Social Security Death Index. Subjects had a mean (SD) age of 79 (8.6) years and median (IQR) follow-up time of 1.6 (0.4–3.0) years. Blacks and Hispanics had similar mortality rates compared to whites (adjusted-hazard ratio [HR] 0.92, 95% CI 0.76–1.11 and adjusted-HR 0.92, 95% CI 0.76–1.12, respectively). Compared to those with commercial insurance and Medicare, higher mortality rates were observed for those with Medicare only (adjusted-HR 1.43, 95% CI 1.03–1.98) and Medicaid (adjusted-HR 1.30, 95% CI 1.10–1.52). Medicaid recipients who were the oldest ICU survivors (age >82 years), survivors of mechanical ventilation, and discharged to skilled-care facilities had the highest mortality rates (p-for-interaction 0.08, 0.03, and 0.17, respectively). Conclusions Mortality after critical illness among older adults varies by insurance coverage, but not by race or ethnicity. Those with federal or state insurance coverage only had higher mortality rates than those with additional commercial insurance.