An Innovative Individual-Level Socioeconomic Measure Predicts Critical Care Outcomes in Older Adults: A Population-Based Study

Amelia Barwise, Chung Il Wi, Ryan Frank, Bojana Milekic, Nicole Andrijasevic, Naresh Veerabattini, Sidhant Singh, Michael E. Wilson, Ognjen Gajic, Young J. Juhn

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Little is known about the impact of socioeconomic status (SES) as a key element of social determinants of health on intensive care unit (ICU) outcomes for adults. Objective: We assessed whether a validated individual SES index termed HOUSES (HOUsing-based SocioEconomic status index) derived from housing features was associated with short-term outcomes of critical illness including ICU mortality, ICU-free days, hospital-free days, and ICU readmission. Methods: We performed a population-based cohort study of adult patients living in Olmsted County, Minnesota, admitted to 7 intensive care units at Mayo Clinic from 2011 to 2014. We compared outcomes between the lowest SES group (HOUSES quartile 1 [Q1]) and the higher SES group (HOUSES Q2-4). We stratified the cohort based on age (<50 years old and ≥50 years old). Results: Among 4134 eligible patients, 3378 (82%) patients had SES successfully measured by the HOUSES index. Baseline characteristics, severity of illness, and reason for ICU admission were similar among the different SES groups as measured by HOUSES except for larger number of intoxications and overdoses in younger patients from the lowest SES. In all adult patients, there were no overall differences in mortality, ICU-free days, hospital-free days, or ICU readmissions in patients with higher SES compared to lower SES. Among older patients (>50 years), those with higher SES (HOUSES Q2-4) compared to those with lower SES (HOUSES Q1) had lower mortality rates (hazard ratio = 0.72; 95% CI: 0.56-0.93; adjusted P =.01), increased ICU-free days (mean 1.08 days; 95% CI: 0.34-1.84; adjusted P =.004), and increased hospital-free days (mean 1.20 days; 95% CI: 0.45-1.96; adjusted P =.002). There were no differences in ICU readmission rates (OR = 0.74; 95% CI: 0.55-1.00; P =.051). Conclusion: Individual-level SES may be an important determinant or predictor of critical care outcomes in older adults. Housing-based socioeconomic status may be a useful tool for enhancing critical care research and practice.

Original languageEnglish (US)
JournalJournal of Intensive Care Medicine
DOIs
StateAccepted/In press - 2020

Keywords

  • ICU outcomes
  • Socioeconomic status
  • critical care
  • critical illness
  • length of stay
  • social determinants of health

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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