Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study

Quenot, Jean-Pierre; Helms, Julie; Labro, Guylaine; Dargent, Auguste; Meunier-Beillard, Nicolas; Ksiazek, Eléa; Bollaert, Pierre‐Édouard; Louis, Guillaume; Large, Audrey; Andreu, Pascal; Bein, C.; Rigaud, Jean‐Philippe; Perez, Pierre; Clère-Jehl, Raphaël; Merdji, Hamid; Devilliers, H.; Binquet, Christine; Meziani, Ferhat; Fournel, Isabelle

doi:10.1186/s13613-020-0637-1

Cited by 14 publications

(27 citation statements)

References 52 publications

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“…The risk of adverse health events, ICU admission and death are thought to be higher in people living in more deprived areas and this has been indicated in England and more recently in our study in Wales [3,14]. Interestingly international comparisons do not support this, notably in France multiple studies have shown no adverse association with low socioeconomic status and initial severity of illness on ICU admission or long-term outcome [15][16]. Currently, there is no definitive data on this subject in relation to COVID-19 disease.…”

Section: Discussionsupporting

confidence: 51%

<strong>Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales – the Interplay between Ethnicity and Deprivation</strong>

Baumer¹,

Phillips²,

Dhadda³

et al. 2020

Preprint

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On the 9th March 2020, the first patient with COVID-19 was admitted to ICU in the Royal Gwent Hospital, Newport, Wales. We prospectively recorded the rate of ICU admissions of 52 patients with COVID-19 over 60 days, focusing on the epidemiology of ethnicity and deprivation. Patients were 65% (34 of 52) male and had a median (IQR) age of 55 (48-62) years. Prevalent comorbidities included obesity (52%); diabetes (33%), and asthma (23%). COVID-19 hospital and ICU inpatient numbers peaked on days 23 and 39, respectively – a lag of 16 days. The ICU mortality rate was 33% (17 of 52). Black, Asian and Minority Ethnics (BAME) population represented 35% of ICU COVID-19 admissions (18 of 52) and 35% of deaths (6 of 17). Within the BAME group, 72% (13 of 18) were found to reside in geographical areas representing the 20% most deprived in Wales, versus 27% of Caucasians (9 of 33). Less than 5% of the population within the hospital catchment area are of BAME descent, yet they represent a disproportionately high proportion of patients with ICU admission and mortality suffering from COVID-19. The interplay between ethnicity and deprivation, which is complex, may be a factor in our findings. This in turn could be related to an increased prevalence of co-morbidities; higher community exposure; or genetic polymorphisms.

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Section: Discussionsupporting

confidence: 51%

<strong>Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales – the Interplay between Ethnicity and Deprivation</strong>

Baumer¹,

Phillips²,

Dhadda³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Socioeconomic advantage and disadvantage did not contribute to mortality in the present study, consistent with previous studies. 31,32 However, increasing remoteness was associated with decreased mortality risk, a finding that has been reported previously in non-CKD5Dspecific studies. 33 There are several potential explanations for this finding.…”

Section: Discussionsupporting

confidence: 59%

Characteristics and outcomes of Aboriginal and Torres Strait Islander patients with dialysis‐dependent kidney disease in Australian intensive care units

Dunlop

Secombe²,

Agostino

et al. 2022

Internal Medicine Journal

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Background: In Australia, 531 people per million population have dialysis-dependent chronic kidney disease (CKD5D). The incidence is four times higher for Aboriginal and Torres Strait Islander (indigenous) people compared with non-Indigenous Australians. CKD5D increases the risk of hospitalisation, admission to the intensive care unit (ICU) and mortality compared with patients without CKD5D. There is limited literature describing short-term outcomes of patients with CKD5D who are admitted to the ICU, comparing indigenous and non-indigenous patients.Aims: This registry-based retrospective cohort analysis compared demographic and clinical data between indigenous and non-indigenous patients with CKD5D and tested whether indigenous status predicted short-term outcomes independently of other contributing factors. Adjusted hospital mortality was the primary outcome measure. Methods: Data were from the Australian and New Zealand Intensive Care Society's Centre for Outcome and Resource Evaluation Adult Patient Database. Australian ICU admissions between 2010 and 2017 were included. Data from 173 ICU (2136 beds) include 1 051 697 ICU admissions, of which 23 793 had a pre-existing diagnosis of CKD5D.Results: Indigenous patients comprised 11.9% of CKD5D patients in ICU. CKD5D was prevalent among 4.9% of indigenous and 2.9% of non-indigenous ICU admissions. Indigenous patients were 13.5 years younger, had fewer comorbidities and lower crude mortality despite equivalent calculated mortality risk. After adjusting for age, remoteness and severity of illness, indigenous status did not predict mortality.Conclusions: Socioeconomic disadvantage contributes to earlier development of CKD5D and the overrepresentation in ICU of indigenous people. Mortality is equivalent once correcting for confounders, but addressing inequality requires strengthening preventative care.

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“…The risk of adverse health events, ICU admission and death are thought to be higher in people living in more deprived areas and this has been indicated in England and more recently in our study in Wales ( 3 , 20 ). Interestingly international comparisons do not support this, notably in France multiple studies have shown no adverse association with low socioeconomic status and initial severity of illness on ICU admission or long-term outcome ( 21 , 22 ). Currently, there is no definitive data on this subject in relation to COVID-19 disease.…”

Section: Discussionmentioning

confidence: 98%

Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales—The Interplay Between Ethnicity and Deprivation

et al. 2020

View full text Add to dashboard Cite

On the 9th March 2020, the first patient with COVID-19 was admitted to ICU in the Royal Gwent Hospital (RGH), Newport, Wales. We prospectively recorded the rate of ICU admissions of 52 patients with COVID-19 over 60 days, focusing on the epidemiology of ethnicity and deprivation because these factors have emerged as significant risk factors. Patients were 65% (34 of 52) male and had a median (IQR) age of 55 (48-62) years. Prevalent comorbidities included obesity (52%); diabetes (33%), and asthma (23%). COVID-19 hospital and ICU inpatient numbers peaked on days 23 and 39, respectively-a lag of 16 days. The ICU mortality rate was 33% (17 of 52). People of black, Asian, and minority ethnic descent (BAME group) represented 35% of ICU COVID-19 admissions (18 of 52) and 35% of deaths (6 of 17). Amongst the BAME group, 72% (13 of 18) of patients were found to reside in geographical areas representing the 20% most deprived in Wales, vs. 27% of patients in the Caucasian group (9 of 33). Less than 5% of the population within the area covered by RGH are of BAME descent, yet this group had a disproportionately high ICU admission and mortality rate from COVID-19. The interplay between ethnicity and deprivation, which is complex, may be a factor in our findings. This in turn could be related to an increased prevalence of co-morbidities; higher community exposure; larger proportion of lower band key worker roles; or genetic polymorphisms.

show abstract

Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study

Cited by 14 publications

References 52 publications

<strong>Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales – the Interplay between Ethnicity and Deprivation</strong>

<strong>Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales – the Interplay between Ethnicity and Deprivation</strong>

Characteristics and outcomes of Aboriginal and Torres Strait Islander patients with dialysis‐dependent kidney disease in Australian intensive care units

Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales—The Interplay Between Ethnicity and Deprivation

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Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study

Cited by 14 publications

References 52 publications

<strong>Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales &ndash; the Interplay between Ethnicity and Deprivation</strong>

<strong>Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales &ndash; the Interplay between Ethnicity and Deprivation</strong>

Characteristics and outcomes of Aboriginal and Torres Strait Islander patients with dialysis‐dependent kidney disease in Australian intensive care units

Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales—The Interplay Between Ethnicity and Deprivation

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Product

Resources

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<strong>Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales – the Interplay between Ethnicity and Deprivation</strong>

<strong>Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales – the Interplay between Ethnicity and Deprivation</strong>