Racial Disparities in Invasive ICU Treatments Among Septic Patients: High Resolution Electronic Health Records Analysis from MIMIC-IV.

IF 2.5 3区 工程技术 Q2 BIOLOGY Yale Journal of Biology and Medicine Pub Date : 2023-09-29 eCollection Date: 2023-09-01 DOI:10.59249/WDJI8829
Sara Mohammed, João Matos, Matthieu Doutreligne, Leo Anthony Celi, Tristan Struja
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Abstract

Background: Low-resolution administrative databases can give biased results, whereas high-resolution, time-stamped variables from clinical databases like MIMIC-IV might provide nuanced insights. We evaluated racial-ethnic disparities in life-sustaining ICU-treatments (Invasive Mechanical Ventilation (IMV), Renal Replacement Therapy (RRT), and Vasopressors (VP)) among patients with sepsis. Methods: In this observational retrospective cohort study, patients fulfilling sepsis-3 criteria were categorized by treatment assignment within the first 4 days. The outcomes were treatment allocations. The likelihood of receiving treatment was calculated by race-ethnicity (Racial-ethnic group (REG) or White group (WG)) using 5-fold sub-sampling nested logistic regression and XGBoost. Results: In 23,914 admissions, 82% were White, 42% were women. REG were less likely to receive IMV across all eligibility days (day 1 odds ratio (OR) 0.87, 95% confidence interval (CI) 0.83-0.94, day 4 OR 0.80, 95% CI 0.72 - 0.87). There were no differences in RRT (day 1 OR 1.00, 95% CI 0.96-1.09, day 4 OR 1.00, 95% CI 0.94-1.06). REG were also less likely to be treated with VP at days 1 to 3 (day 1 OR 0.87, 95% CI 0.76-0.94), but not at day 4 (OR 0.95, 95% CI 0.87-1.01). These findings remained robust when relaxing eligibility criteria for treatment allocation. Conclusion: Our findings reveal significant disparities in the use of invasive life-saving ICU treatments among septic patients from racial and ethnic minority backgrounds, particularly with respect to IMV and VP use. These disparities underscore not only the need to address inequality in critical care settings, but also highlight the importance of high-resolution data.

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败血症患者侵入性ICU治疗中的种族差异:来自MIMIC-IV的高分辨率电子健康记录分析。
背景:低分辨率管理数据库可能会给出有偏差的结果,而来自MIMIC-IV等临床数据库的高分辨率、带时间戳的变量可能会提供细微的见解。我们评估了败血症患者在维持生命的ICU治疗(有创机械通气(IMV)、肾脏替代治疗(RRT)和血管加压素(VP))方面的种族-民族差异。方法:在这项观察性回顾性队列研究中,符合sepsis-3标准的患者在最初4天内按治疗分配进行分类。结果是治疗分配。接受治疗的可能性通过种族-民族(种族-民族组(REG)或白人组(WG))使用5倍亚抽样嵌套逻辑回归和XGBoost计算。结果:在23914名住院患者中,82%为白人,42%为女性。REG在所有符合条件的天数内接受IMV的可能性较小(第1天比值比(OR)0.87,95%置信区间(CI)0.83-0.94,第4天比值比0.80,95%CI 0.72-0.87)。RRT没有差异(第1天比值比1.00,95%CI 0.96-1.09,第4天比值比1.0095%CI 0.94-1.06)。REG在第1-3天接受VP治疗的可能性也较小(第2天比值比0.87,95%CI 0.76-0.94),但在第4天没有(OR 0.95,95%CI 0.87-1.01)。当放宽治疗分配的资格标准时,这些发现仍然很有力。结论:我们的研究结果揭示了来自种族和少数民族背景的败血症患者在使用侵入性救生ICU治疗方面的显著差异,特别是在IMV和VP使用方面。这些差异不仅突出了解决重症监护环境中不平等问题的必要性,还突出了高分辨率数据的重要性。
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来源期刊
Yale Journal of Biology and Medicine
Yale Journal of Biology and Medicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology
CiteScore
5.00
自引率
0.00%
发文量
41
期刊介绍: The Yale Journal of Biology and Medicine (YJBM) is a graduate and medical student-run, peer-reviewed, open-access journal dedicated to the publication of original research articles, scientific reviews, articles on medical history, personal perspectives on medicine, policy analyses, case reports, and symposia related to biomedical matters. YJBM is published quarterly and aims to publish articles of interest to both physicians and scientists. YJBM is and has been an internationally distributed journal with a long history of landmark articles. Our contributors feature a notable list of philosophers, statesmen, scientists, and physicians, including Ernst Cassirer, Harvey Cushing, Rene Dubos, Edward Kennedy, Donald Seldin, and Jack Strominger. Our Editorial Board consists of students and faculty members from Yale School of Medicine and Yale University Graduate School of Arts & Sciences. All manuscripts submitted to YJBM are first evaluated on the basis of scientific quality, originality, appropriateness, contribution to the field, and style. Suitable manuscripts are then subject to rigorous, fair, and rapid peer review.
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