Effect of socioeconomic status on mortality and care provision among critically ill adult patients
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AbstractBackground: Socioeconomic status (SES) has been recognized as an important determinant of health outcomes and healthcare utilization across a variety of chronic and infectious diseases in Canada and internationally. However, the effect of SES on mortality and care provision among critically ill patients has been little investigated. Most importantly, no Canadian study has been completed to date to investigate the distribution and effects of SES in the critically ill. Broadly, the objectives of this study were to investigate whether differences exist in mortality and care provision by SES among adult critically ill patients in a Canadian health region. Methods: This was a population-based retrospective cohort study of patients admitted to intensive care (ICU) in the Calgary Health Region (CHR) between January 2002 and December 2006. The primary outcome measures were hospital and I-year mortality. Median household income, obtained from the 2001 Canadian census, was the primary exposure variable. Receipt of welfare or healthcare premium subsidy and Aboriginal status were the secondary exposure measures. The eventual study sample consisted of 6,822 critically ill CHR residents. ICU and hospital clinical data were linked with the primary exposure data using the Postal Code Conversion File, available from Statistics Canada through the Academic Data Centre at the University of Calgary. Clinical data were linked with secondary exposure data through the CHR population registry file. Descriptive and adjusted analyses of mortality, access to care and intensity of care was undertaken by median household income, welfare/subsidy receipt and Aboriginal status. Results: This study demonstrated a lack of association between SES and hospital mortality or mortality up to 1-year after critical illness. Further, low income, defined by receipt of welfare/subsidy, and Aboriginal status was not associated with increased mortality among critically ill patients. Importantly, these data also show that lower SES is associated with greater use of/access to critical care services; however no differences in intensity of care in ICU or hospital existed by SES. Discussion: The results of this study provide reassurance that hospital and 1-year outcomes after critical illness in the CHR do not differ by SES and highlight the increased need for critical care among individuals oflower SES. Further research is required to investigate whether longer-term outcomes are influenced by SES and to examine the exact nature of the relationship between SES and incidence of critical illness. These results have implications for ICU clinicians interested in optimizing long-term outcomes and for health policy makers interested in evidence-based resource allocation.
Bibliography: p. 176-192