Association of Area Deprivation Index With Mortality in Critically Ill Adults With COVID-19.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE American Journal of Critical Care Pub Date : 2024-11-01 DOI:10.4037/ajcc2024898

Ronald Harris, Morgan Rosser, Anand M Chowdhury, Tetsu Ohnuma, Karthik Raghunathan, Krista L Haines, Vijay Krishnamoorthy

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Abstract

Background: Various social determinants of health have been established as significant risk factors for COVID-19 transmission, prevalence, incidence, and mortality. Area deprivation index (ADI, a composite score made up of educational, housing, and poverty markers) is an accepted multidimensional social determinants of health measure. Little is known about how structural social determinants of health before hospitalization, including ADI, may affect mortality related to COVID-19 in critically ill patients.

Objectives: To examine the association of ADI with intensive care unit (ICU) mortality in patients with COVID-19 and compare its predictive power with that of clinical factors.

Methods: This was a retrospective cohort study of critically ill adults with COVID-19 in 3 hospitals within a single health system. Multivariable logistic regression models (adjusted for demographic and clinical variables) were used to examine the association of ADI with ICU mortality.

Results: Data from 1784 patients hospitalized from 2020 to 2022 were analyzed. In multivariable models, no association was found between national ADI and ICU mortality. Notable factors associated with ICU mortality included treatment year, age, van Walraven weighted score, invasive mechanical ventilation, and body mass index.

Conclusion: In this study, clinical factors were more predictive of mortality than ADI and other social determinants of health. The influence of ADI may be most relevant before hospital admission. These findings could serve as a foundation for shaping targeted public health strategies and hospital interventions, enhancing care delivery, and potentially contributing to better outcomes in future pandemics.

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地区贫困指数与 COVID-19 重症成人死亡率的关系。

背景：各种健康的社会决定因素已被确定为 COVID-19 传播、流行、发病和死亡的重要风险因素。地区贫困指数（ADI，由教育、住房和贫困指标组成的综合评分）是一种公认的多维健康社会决定因素衡量标准。人们对住院前健康的结构性社会决定因素（包括 ADI）如何影响重症患者与 COVID-19 相关的死亡率知之甚少：研究 ADI 与 COVID-19 患者重症监护病房（ICU）死亡率的关系，并比较 ADI 与临床因素的预测能力：这是一项回顾性队列研究，研究对象是同一医疗系统内 3 家医院的 COVID-19 重症成人患者。采用多变量逻辑回归模型（根据人口统计学和临床变量进行调整）研究 ADI 与 ICU 死亡率的关系：结果：分析了2020年至2022年住院的1784名患者的数据。在多变量模型中，未发现国家 ADI 与 ICU 死亡率之间存在关联。与重症监护室死亡率相关的显著因素包括治疗年份、年龄、范瓦尔拉文加权评分、有创机械通气和体重指数：在这项研究中，临床因素比 ADI 和其他健康社会决定因素更能预测死亡率。ADI 的影响可能在入院前最为明显。这些发现可作为制定有针对性的公共卫生策略和医院干预措施的基础，加强护理服务，并有可能在未来的大流行病中取得更好的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Critical Care 医学-护理

CiteScore

4.30

自引率

3.70%

发文量

103

审稿时长

6-12 weeks

期刊介绍： The editors of the American Journal of Critical Care (AJCC) invite authors to submit original manuscripts describing investigations, advances, or observations from all specialties related to the care of critically and acutely ill patients. Papers promoting collaborative practice and research are encouraged. Manuscripts will be considered on the understanding that they have not been published elsewhere and have been submitted solely to AJCC.

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