Influence of Socioeconomic Deprivation on Interventions and Outcomes for Patients Admitted with COVID-19 to Critical Care Units in Scotland: A National Cohort Study

Abstract

Background: Coronavirus disease 2019 (COVID-19) can lead to significant respiratory failure with between 14% and 18% of hospitalised patients requiring critical care admission. This study describes the impact of socioeconomic deprivation on 30-day survival following critical care admission for COVID-19, and the impact of the COVID-19 pandemic on critical care capacity in Scotland. Methods: This cohort study used linked national hospital records including ICU, virology testing and national death records to identify and describe patients with COVID-19 admitted to critical care units in Scotland. Multivariable logistic regression was used to assess the impact of deprivation on 30-day mortality. Critical care capacity was described by reporting the percentage of baseline ICU bed utilisation required. Findings: There were 735 patients with COVID-19 admitted to critical care units across Scotland from 1/3/ 2020 to 20/6/2020. There was a higher proportion of patients from more deprived areas, with 183 admissions (24.9%) from the most deprived quintile and 100 (13.6%) from the least deprived quintile. Overall, 30-day mortality was 34.8%. After adjusting for age, sex and ethnicity, mortality was significantly higher in patients from the most deprived quintile (OR 1.97, 95%CI 1.13, 3.41, p=0.016). ICUs serving populations with higher levels of deprivation spent a greater amount of time over their baseline ICU bed capacity. Interpretation: Patients with COVID-19 living in areas with greatest socioeconomic deprivation had a higher frequency of critical care admission and a higher adjusted 30-day mortality. ICUs in health boards with higher levels of socioeconomic deprivation had both higher peak occupancy and longer duration of occupancy over normal maximum capacity.

Support for self-isolation is critical in covid-19 response

“…Striking and widening disparities in covid-19 related outcomes have highlighted the intersection of socioeconomic disadvantage and health inequalities, enhanced by structural racism 1234. Socioeconomically disadvantaged and many ethnic minority groups have been disproportionately affected, with increased risk of infection, hospital admission, and death 5678…”

Inequalities in population health loss by multiple deprivation: COVID-19 and pre-pandemic all-cause disability-adjusted life years (DALYs) in Scotland

“…Our analyses assumed that the distribution of YLD by area deprivation was the same as the proportional distribution of YLL. We believe this to be a rational choice, given that total YLD is estimated to be around 2% of DALYs, and that the pattern of cases which have been observed have indicated similar patterns by deprivation [29]. Area deprivation is however known to underestimate the true inequalities experienced by socioeconomic position because only a proportion of the most deprived individuals live in deprived areas (and vice versa).…”

Socio-Economic Patterns of COVID-19 During the Pandemic in Italy

“…Some studies have found higher hospitalisation and mortality rates in the most deprived areas of the UK (16,(45)(46)(47)(48), as well as in the US (18,49). These findings could reflect the known social gradient in co-morbidities and risk factors for COVID-19 severity, such as obesity, diabetes, cardiovascular disease or respiratory diseases, by which those living in the most deprived areas suffer the biggest burden.…”