Race and ethnicity in the intensive care unit: What do we know and where are we going?*

Muni, Sarah; Curtis, J. Randall

doi:10.1097/ccm.0b013e31820a85be

Cited by 3 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Seven studies reported length of stay data and compared patients based on race; however, there were no statistically significant differences noted (19, 20, 23, 25, 26, 28, 33). Studies examining several other critical care outcome measures—for example, subspecialty care, appropriate antibiotic use, and ICU transitions in care—did find differences by race, even after controlling for confounding variables (16, 23, 25, 27, 34).…”

Section: Resultsmentioning

confidence: 99%

“…In a cohort of heart failure patients requiring mechanical ventilation, a study by Wiskar et al (39) found that Black and Hispanic patients had lower odds of palliative care consultation than White patients. Among a multicenter cohort of patients who died in the ICU, Muni and Curtis (19) found that non-White patients were less likely to have advanced care planning documents, less likely to have a DNR order or comfort care measures, and more likely to die with full support in place. In the survey by Lee et al (41) of family members of patients who died in the ICU, minority of patients' family members reported lower quality rating of death and dying compared with families of White patients.…”

Section: Table 4 (Continued )mentioning

confidence: 99%

“…Although past attempts to summarize the literature on the topic of racial disparities in the ICU have been made (19, 20), the literature has not been examined using a systematic approach, and whether racial disparities in ICU care contributes to increased mortality among minority patients has not been fully explored. To our knowledge, this is the first comprehensive systematic review examining the role of racial disparities in clinical outcomes in the ICU.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Racial Disparities in ICU Outcomes: A Systematic Review*

McGowan

Sarigiannis

Fox

et al. 2021

Critical Care Medicine

View full text Add to dashboard Cite

OBJECTIVES: Racial disparities in the United States healthcare system are well described across a variety of clinical settings. The ICU is a clinical environment with a higher acuity and mortality rate, potentially compounding the impact of disparities on patients. We sought to systematically analyze the literature to assess the prevalence of racial disparities in the ICU. DATA SOURCES:We conducted a comprehensive search of PubMed/ MEDLINE, Scopus, CINAHL, and the Cochrane Library. STUDY SELECTION:We identified articles that evaluated racial differences on outcomes among ICU patients in the United States. Two authors independently screened and selected articles for inclusion. DATA EXTRACTION:We dual-extracted study characteristics and outcomes that assessed for disparities in care (e.g., in-hospital mortality, ICU length of stay). Studies were assessed for bias using the Newcastle-Ottawa Scale.DATA SYNTHESIS: Of 1,325 articles screened, 25 articles were included (n = 751,796 patients). Studies demonstrated race-based differences in outcomes, including higher mortality rates for Black patients when compared with White patients. However, when controlling for confounding variables, such as severity of illness and hospital type, mortality differences based on race were no longer observed. Additionally, results revealed that Black patients experienced greater financial impacts during an ICU admission, were less likely to receive early tracheostomy, and were less likely to receive timely antibiotics than White patients. Many studies also observed differences in patients' end-of-life care, including lower rates on the quality of dying, less advanced care planning, and higher intensity of interventions at the end of life for Black patients. CONCLUSIONS:This systematic review found significant differences in the care and outcomes among ICU patients of different races. Mortality differences were largely explained by accompanying demographic and patient factors, highlighting the effect of structural inequalities on racial differences in mortality in the ICU. This systematic review provides evidence that structural inequalities in care persist in the ICU, which contribute to racial disparities in care. Future research should evaluate interventions to address inequality in the ICU.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Table 4 (Continued )mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Racial Disparities in ICU Outcomes: A Systematic Review*

McGowan

Sarigiannis

Fox

et al. 2021

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…While longer-term goals include improved outcomes for these vulnerable patients and reducing healthcare-related expenditures, short-term policy priorities would involve modeling the impact of increased number of IMV patients on California EDs. 8 , 39 More research is needed to confirm our main findings with additional lines of research to determine necessary levels of ED staffing, strategies to decrease ER boarding times, and to quantify resource allocation for safety net EDs.…”

Section: Discussionmentioning

confidence: 67%

Invasive Mechanical Ventilation in California Over 2000-2009: Implications for Emergency Medicine

Mudumbai¹,

Barr²,

Scott³

et al. 2015

WestJEM

View full text Add to dashboard Cite

IntroductionPatients who require invasive mechanical ventilation (IMV) often represent a sequence of care between the emergency department (ED) and intensive care unit (ICU). Despite being the most populous state, little information exists to define patterns of IMV use within the state of California.MethodsWe examined data from the masked Patient Discharge Database of California’s Office of Statewide Health Planning and Development from 2000–2009. Adult patients who received IMV during their stay were identified using the International Classification of Diseases 9th Revision and Clinical Modification procedure codes (96.70, 96.71, 96.72). Patients were divided into age strata (18–34yr, 35–64yr, and >65yr). Using descriptive statistics and regression analyses, for IMV discharges during the study period, we quantified the number of ED vs. non-ED based admissions; changes in patient characteristics and clinical outcome; evaluated the marginal costs for IMV; determined predictors for prolonged acute mechanical ventilation (PAMV, i.e. IMV>96hr); and projected the number of IMV discharges and ED-based admissions by year 2020.ResultsThere were 696,634 IMV discharges available for analysis. From 2000–2009, IMV discharges increased by 2.8%/year: n=60,933 (293/100,000 persons) in 2000 to n=79,868 (328/100,000 persons) in 2009. While ED-based admissions grew by 3.8%/year, non-ED-based admissions remained stable (0%). During 2000–2009, fastest growth was noted for 1) the 35–64 year age strata; 2) Hispanics; 3) patients with non-Medicare public insurance; and 4) patients requiring PAMV. Average total patient cost-adjusted charges per hospital discharge increased by 29% from 2000 (from $42,528 to $60,215 in 2014 dollars) along with increases in the number of patients discharged to home and skilled nursing facilities. Higher marginal costs were noted for younger patients (ages 18–34yr), non-whites, and publicly insured patients. Some of the strongest predictors for PAMV were age 35–64 years (OR=1.12; 95% CI [1.09–1.14], p<0.05); non-Whites; and non-Medicare public insurance. Our models suggest that by 2020, IMV discharges will grow to n=153,153 (377 IMV discharges/100,000 persons) with 99,095 admitted through the ED.ConclusionBased on sustained growth over the past decade, by the year 2020, we project a further increase to 153,153 IMV discharges with 99,095 admitted through the ED. Given limited ICU bed capacities, ongoing increases in the number and type of IMV patients have the potential to adversely affect California EDs that often admit patients to ICUs.

show abstract