The effect of race and ethnicity on outcomes among patients in the intensive care unit: A comprehensive study involving socioeconomic status and resuscitation preferences*

Abstract

Objective We sought to determine whether race or ethnicity is independently associated with mortality or intensive care unit (ICU) length of stay (LOS) among critically ill patients after accounting for patients' clinical and demographic characteristics including socioeconomic status and resuscitation preferences. Design Historical cohort study of patients hospitalized in intensive care units. Setting Adult intensive care units in 35 California hospitals during the years 2001-2004. Patients A total of 9,518 ICU patients (6334 white, 655 black, 1917 Hispanic and 612 Asian/Pacific Islander patients). Measurements and Main Results The primary outcome was risk-adjusted mortality and a secondary outcome was risk-adjusted ICU LOS. Crude hospital mortality was 15.9% among the entire cohort. Asian patients had the highest crude hospital mortality at 18.6% and black patients had the lowest at 15.0%. After adjusting for age and gender, Hispanic and Asian patients had a higher risk of death compared to white patients, but these differences were not significant after additional adjustment for severity of illness. Black patients had more acute physiologic derangements at ICU admission and longer unadjusted ICU LOS. ICU LOS was not significantly different among racial/ethnic groups after adjustment for demographic, clinical, socioeconomic factors and do-not-resuscitate status. In an analysis restricted only to those who died, decedent black patients averaged 1.1 additional days in the ICU (95% CI – 0.26 to 2.6) compared to white patients who died, although this was not statistically significant. Conclusions Hospital mortality and ICU LOS did not differ by race or ethnicity among this diverse cohort of critically ill patients after adjustment for severity of illness, resuscitation status, SES, insurance status and admission type. Black patients had more acute physiologic derangements at ICU admission and were less likely to have a DNR order. These results suggest that among ICU patients, there are not racial or ethnic differences in mortality within individual hospitals. If disparities in ICU care exist, they may be explained by differences in the quality of care provided by hospitals that serve high proportions of minority patients.

Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness

“…The quality of ICU care patients receive may not vary by race/ethnicity in way that affects post-discharge survival. A recent study found that while blacks and Hispanics present with a higher severity of critical illness, in-hospital mortality does not differ by race/ethnicity after controlling for severity of illness, resuscitation preferences, socioeconomic status, and insurance coverage (11). Similarly, we found that blacks and Hispanics may have been more acutely critically ill at presentation insofar as they used more mechanical ventilation and had a longer ICU length of stay than whites, but long-term mortality did not vary by race/ethnicity.…”

“…acute lung injury, sepsis, sudden cardiac death (7–9)). However, after adjustment for disease severity, in-hospital mortality rates for these critical illnesses do not appear to vary by race (7, 10, 11). Whether racial and ethnic differences in mortality exist after hospitalization for critical illness remains unknown.…”

The Effect of Obesity on Outcomes in Mechanically Ventilated Patients in a Medical Intensive Care Unit

“…Blacks might possibly have different physiologic responses to acute, severe illness [31]. In secondary analyses of large ICU cohorts, blacks had more severe acute physiologic derangements at ICU admission [32,33]. However, retrospective database analyses suggested that blacks are less likely to develop the systemic inflammatory response syndrome after trauma [34] and are more likely to survive post-traumatic sepsis [35].…”

Body Mass Index and Intensive Care Unit Outcomes in African American Patients

“…Obesity is associated with increased morbidity and all-cause mortality. 10,25 In secondary analyses of large ICU cohorts, Black patients were found to have more severe acute physiologic derangements at ICU admission 12,26 suggesting that Black's physiologic response to critical illness might be different. Intuitively, one would think, these factors would contribute to worse outcomes among critithat obesity was not associated with an increased risk of ICU mortality (relative risk [RR], 1.00; 95% CI, .86-1.16; P=.970) and improved survival was observed for class I and class II obesity patients compared with none obese patients (RR, .86; 95% CI, .81-.91; P<.001).…”

“…Few prior studies have assessed the effect of BMI on medical ICU outcomes in African American (AA) patients. 11,12 The results from previous studies and three meta-analyses addressing this topic [13][14][15] have mostly been from mixed medical-surgical ICU populations [13][14][15][16][17][18] and did not include a subgroup analysis by race or the type of ICU (trauma, surgical vs medical) to which patients were admitted. In studies including only patients admitted to medical ICUs (MICU), some lacked appropriate non-obese comparison, 19,20 others used a different definition of obesity 21 or included only limited BMI groups.…”