tetano
Editor, Senior Moderator
Lancet Reg Health Eur
. 2021 Feb;1:100005.
doi: 10.1016/j.lanepe.2020.100005. Epub 2020 Dec 15.
Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with COVID-19 to critical care units in Scotland: A national cohort study
Nazir I Lone[SUP] 1 2 [/SUP], Joanne McPeake[SUP] 3 [/SUP], Neil I Stewart[SUP] 4 [/SUP], Michael C Blayney[SUP] 1 5 [/SUP], Robert Chan Seem[SUP] 5 [/SUP], Lorraine Donaldson[SUP] 5 [/SUP], Elaine Glass[SUP] 6 [/SUP], Catriona Haddow[SUP] 5 [/SUP], Ros Hall[SUP] 5 [/SUP], Caroline Martin[SUP] 5 [/SUP], Martin Paton[SUP] 5 [/SUP], Alison Smith-Palmer[SUP] 5 [/SUP], Callum T Kaye[SUP] 7 [/SUP], Kathryn Puxty[SUP] 3 [/SUP], Scottish Intensive Care Society Audit Group
Affiliations
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.
. 2021 Feb;1:100005.
doi: 10.1016/j.lanepe.2020.100005. Epub 2020 Dec 15.
Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with COVID-19 to critical care units in Scotland: A national cohort study
Nazir I Lone[SUP] 1 2 [/SUP], Joanne McPeake[SUP] 3 [/SUP], Neil I Stewart[SUP] 4 [/SUP], Michael C Blayney[SUP] 1 5 [/SUP], Robert Chan Seem[SUP] 5 [/SUP], Lorraine Donaldson[SUP] 5 [/SUP], Elaine Glass[SUP] 6 [/SUP], Catriona Haddow[SUP] 5 [/SUP], Ros Hall[SUP] 5 [/SUP], Caroline Martin[SUP] 5 [/SUP], Martin Paton[SUP] 5 [/SUP], Alison Smith-Palmer[SUP] 5 [/SUP], Callum T Kaye[SUP] 7 [/SUP], Kathryn Puxty[SUP] 3 [/SUP], Scottish Intensive Care Society Audit Group
Affiliations
- PMID: 34173618
- PMCID: PMC7834626
- DOI: 10.1016/j.lanepe.2020.100005
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.