A paucity of literature exists about the relationship between ethnicity and insurance status and the rate of packed red blood cell transfusion in the critically ill. We chose to evaluate the impact of ethnicity and insurance status on the rate of PRBC transfusion in patients admitted to the ICU.
4.5 year retrospective analysis of the Project Impact database. Data included Ethnicity [White (W), African-American (A), Hispanic (H)]; Transfused (T) or not (NT), age, gender, APACHE II, Hct, and insurance status private/commercial (P), Medicare (M), Indigent/Medicaid (I). Ethnic groups were compared for rates of transfusion. Comparisons were also made within each ethnic group by insurance status and within each insurance status by ethnicity. Categorical variables were compared by X2, continuous variables by t-test. Significant findings were evaluated by multivariate analysis.
Total patients: W 3731 (804T); A 1908 (430T); H 658 (122T). M pts were transfused significantly more than both P and I (p < 0.001). Among M patients, both A (p = 0.008) and W (p < 0.001) had higher transfusion rates than H. Compared by ethnicity, A had higher transfusion rates than H (p = 0.031). No other comparisons reached significance. Multivariate analysis using acuity, age, gender and Hct failed to confirm ethnicity or insurance status as an independent predictor of increased likelihood of transfusion.
Adjusting for demographic and clinical factors, ethnicity and insurance status are not independent predictors of likelihood of transfusion.
Ethnicity and the lack of insurance have been implicated as factors in healthcare disparity. In our institution transfusion rates in the ICU appear to be independent of these factors and based on clinical grounds. The applicability of these findings to other institutions needs to be studied.
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