Temporal Trends in Critical Care Outcomes in U.S. Minority-Serving Hospitals

Am J Respir Crit Care Med. 2020 Mar 15;201(6):681-687. doi: 10.1164/rccm.201903-0623OC.

Abstract

Rationale: Whether critical care improvements over the last 10 years extend to all hospitals has not been described.Objectives: To examine the temporal trends of critical care outcomes in minority and non-minority-serving hospitals using an inception cohort of critically ill patients.Measurements and Main Results: Using the Philips Health Care electronic ICU Research Institute Database, we identified minority-serving hospitals as those with an African American or Hispanic ICU census more than twice its regional mean. We examined almost 1.1 million critical illness admissions among 208 ICUs from across the United States admitted between 2006 and 2016. Adjusted hospital mortality (primary) and length of hospitalization (secondary) were the main outcomes. Large pluralities of African American (25%, n = 27,242) and Hispanic individuals (48%, n = 26,743) were cared for in minority-serving hospitals, compared with only 5.2% (n = 42,941) of white individuals. Over the last 10 years, although the risk of critical illness mortality steadily decreased by 2% per year (95% confidence interval [CI], 0.97-0.98) in non-minority-serving hospitals, outcomes within minority-serving hospitals did not improve comparably. This disparity in temporal trends was particularly noticeable among African American individuals, where each additional calendar year was associated with a 3% (95% CI, 0.96-0.97) lower adjusted critical illness mortality within a non-minority-serving hospital, but no change within minority-serving hospitals (hazard ratio, 0.99; 95% CI, 0.97-1.01). Similarly, although ICU and hospital lengths of stay decreased by 0.08 (95% CI, -0.08 to -0.07) and 0.16 (95% CI, -0.16 to -0.15) days per additional calendar year, respectively, in non-minority-serving hospitals, there was little temporal change for African American individuals in minority-serving hospitals.Conclusions: Critically ill African American individuals are disproportionately cared for in minority-serving hospitals, which have shown significantly less improvement than non-minority-serving hospitals over the last 10 years.

Keywords: African American; disparity; minority; mortality.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Critical Care / statistics & numerical data*
  • Critical Care / trends*
  • Critical Care Outcomes
  • Female
  • Hispanic or Latino / statistics & numerical data*
  • Hospitals / statistics & numerical data*
  • Hospitals / trends
  • Humans
  • Male
  • Middle Aged
  • Minority Groups / statistics & numerical data*
  • United States
  • Whites / statistics & numerical data*