Income Disparities In Access To Critical Care Services

Health Aff (Millwood). 2020 Aug;39(8):1362-1367. doi: 10.1377/hlthaff.2020.00581.


The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of intensive care unit (ICU) beds in preventing death from the severe respiratory illness associated with COVID-19. However, the availability of ICU beds is highly variable across the US, and health care resources are generally more plentiful in wealthier communities. We examined disparities in community ICU beds by US communities' median household income. We found a large gap in access by income: 49 percent of the lowest-income communities had no ICU beds in their communities, whereas only 3 percent of the highest-income communities had no ICU beds. Income disparities in the availability of community ICU beds were more acute in rural areas than in urban areas. Policies that facilitate hospital coordination are urgently needed to address shortages in ICU hospital bed supply to mitigate the effects of the COVID-19 pandemic on mortality rates in low-income communities.

Keywords: Access to care; COVID-19; Coronavirus; Critical care; Disparities in access; Elderly care; Health care access; Health equity; Health policy; Health savings accounts; Hospitals; Income disparities; Intensive care; Intensive care units; Low income; Pandemics.

Publication types

  • Multicenter Study

MeSH terms

  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / therapy
  • Critical Care / organization & administration*
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Needs and Demand
  • Healthcare Disparities / economics*
  • Hospital Bed Capacity
  • Humans
  • Income
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Pandemics / prevention & control
  • Pandemics / statistics & numerical data*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / therapy
  • Poverty / statistics & numerical data
  • United States
  • Vulnerable Populations / statistics & numerical data