Association of Economic Status and Mortality in Patients with Acute Respiratory Distress Syndrome

Abstract

The high cost of treatment for acute respiratory distress syndrome (ARDS) is a concern for healthcare systems, while the impact of patients’ socio-economic status on the risk of ARDS-associated mortality remains controversial. This study investigated associations between patients’ income at the time of ARDS diagnosis and ARDS-specific mortality rate after treatment initiation. Data from records provided by the National Health Insurance Service of South Korea were used. Adult patients admitted for ARDS treatment from 2013 to 2017 were included in the study. Patients’ income in the year of diagnosis was evaluated. A total of 14,600 ARDS cases were included in the analysis. The 30-day and 1-year mortality rates were 48.6% and 70.3%, respectively. In multivariable Cox regression model, we compared income quartiles, showing that compared to income strata Q1, the Q2 (p = 0.719), Q3 (p = 0.946), and Q4 (p = 0.542) groups of income level did not affect the risk of 30-day mortality, respectively. Additionally, compared to income strata Q1, the Q2 (p = 0.762), Q3 (p = 0.420), and Q4 (p = 0.189) strata did not affect the risk of 1-year mortality. Patient income at the time of ARDS diagnosis did not affect the risk of 30-day or 1-year mortality in the present study based on South Korea’s health insurance data.

Association Between Socioeconomic Status and Outcomes in Critical Care: A Systematic Review and Meta-Analysis

“…The majority ( n = 33) were published after 2010, of which four reported the impact of the COVID-19 pandemic (17, 18, 27, 29). Most included all admissions to the relevant critical care units, however, some reported outcomes of a specific disease subgroup (21, 31–35). There was diversity in the approach to measuring socioeconomic status—most notably its basis on individual-level measures such as educational attainment, income or housing (3, 29–31, 33, 35–41), or area-based measures (4, 6, 7, 17–28, 32, 34, 42–50).…”

“…Most included all admissions to the relevant critical care units, however, some reported outcomes of a specific disease subgroup (21, 31–35). There was diversity in the approach to measuring socioeconomic status—most notably its basis on individual-level measures such as educational attainment, income or housing (3, 29–31, 33, 35–41), or area-based measures (4, 6, 7, 17–28, 32, 34, 42–50). The latter included studies using a single measure such as poverty rate in the patient’s census tract (21, 22), to studies using indices of multiple deprivation: composite scores derived from up to 39 indicators across several domains (42).…”

“…The 33 studies that reported ICU or in-hospital mortality used time points ranging from 30 days up to 365 days and longer. Nine of these studies (27%) reported significantly higher mortality in the more deprived group across all measures and timeframes (4, 6, 17, 18, 24, 32, 42, 45, 47), while 18 (55%) reported no significant difference in mortality by socioeconomic status regardless of which time point or measure was assessed (7, 19–23, 27, 29, 30, 32, 33, 36, 37, 39, 41, 43, 44, 50). One study reported higher in-hospital mortality in areas with greater postsecondary education rates but no difference when area-level unemployment or median income were considered (48).…”

Incidence, etiology, sociodemographic and clinical characterization of acute respiratory failure in pediatric patients at a high-altitude city: A multicenter cohort study

“…It is important to note that this study was carried out in an urban area, so it was to be expected that most participants were from this area. Even though all institutions admitted patients from all socioeconomic strata, from the highest to the lowest ( 27 , 28 ), it was found that the majority of patients with ARF had a low socioeconomic stratum ( 7 , 28 ), all the patients who died during the study belonged to the low socioeconomic stratum, a finding that coincides with the literature, which shows that social and economic disparities represent a risk factor for developing ARF ( 27 ) and it is also related to higher mortality rates ( 29 ).…”

Associations Between Socioeconomic Status, Patient Risk, and Short-Term Intensive Care Outcomes

“…This was highlighted in a systematic review of health outcomes following critical illness (5). Subsequent studies did not show an association between SES and survival rate (6, 7). International data show variability in the association between SES and mortality in ICU patients (8–17).…”