PURPOSE: Previous research found that critically ill patients without health insurance receive fewer critical care services and may experience worse clinical outcomes. The impact that socioeconomic factors have on ICU outcomes of underserved populations has not been well studied.
METHODS: We performed a retrospective chart review of all patients admitted to the medical ICU at University of Kentucky (UKMC) between 2007 and 2009. Data was collected from hospital admissions data, US Census Bureau, Social Security Death Index and Google Maps. Zip code was used for US Census data analysis of percentage of residents at the poverty level (PL) and percentage at two times the poverty level (PL2). Distance to UKMC was calculated from the patient’s zip code using Google Maps.
RESULTS: There were 2003 admissions to the ICU. Ten admissions were excluded due to lack of data. Mean age was 55.6±16.0 years; 88% were of Caucasian decent and 54% were male. APACHE IV score ranged from 5 to 213 (median 69). The mean PL of the study population was 20.6%±10.5% while the mean PL2 was 43.6%±14.7%. This compares to Kentucky rates of 15.8% and 35.9%, respectively. Insurance status of the cohort include 50% Medicare, 21% Medicaid, 20% private insurance, and 9% self pay. After linear regression analysis, ICU LOS was negatively associated with PL2 (p=0.036), Medicaid insurance (p=0.014) and self pay (p=0.003), but these associations were not significant after adjusting for APACHE IV score. Mortality in the ICU and 30, 90, and 365 days after ICU discharge was not affected by insurance status, distance from UKMC, or poverty level.
CONCLUSIONS: Higher levels of poverty and insurance status do not affect ICU LOS after adjusting for APACHE IV score. Similarly, mortality in the ICU was not affected by miles to UKMC, poverty level or insurance status.
CLINICAL IMPLICATIONS: Although socioeconomic factors have been associated with increased risk of chronic disease and limited access to healthcare, they do not seem to have an effect on ICU outcomes.
DISCLOSURE: The following authors have nothing to disclose: Rayan Ihle, Enrique Diaz-Guzman, Ion Mitrache, David Mannino
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