Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD.
Crit Care Med. 2022 May 1;50(5):733-741. doi: 10.1097/CCM.0000000000005364. Epub 2021 Oct 12.
Factors common to socioeconomically disadvantaged neighborhoods, such as low availability of transportation, may limit access to restorative care services for critical illness survivors. Our primary objective was to evaluate whether neighborhood socioeconomic disadvantage was associated with an increased disability burden after critical illness. Our secondary objective was to determine if the effect differed for those discharged to the community compared with those discharged to a facility.
Longitudinal cohort study with linked Medicare claims data.
United States.
One hundred ninety-nine older adults, contributing to 239 ICU admissions, who underwent monthly assessments of disability for 12 months following hospital discharge in 13 different functional tasks from 1998 to 2017.
Neighborhood disadvantage was assessed using the area deprivation index, a 1-100 ranking evaluating poverty, housing, and employment metrics. Those living in disadvantaged neighborhoods (top quartile of scores) were less likely to self-identify as non-Hispanic White compared with those in more advantaged neighborhoods. In adjusted models, older adults living in disadvantaged neighborhoods had a 9% higher disability burden over the 12 months following ICU discharge compared with those in more advantaged areas (rate ratio, 1.09; 95% Bayesian credible interval, 1.02-1.16). In the secondary analysis adjusting for discharge destination, neighborhood disadvantage was associated with a 14% increase in disability burden over 12 months of follow-up (rate ratio, 1.14; 95% credible interval, 1.07-1.21). Disability burden was 10% higher for those living in disadvantaged neighborhoods and discharged home as compared with those discharged to a facility, but this difference was not statistically significant (interaction rate ratio, 1.10; 95% credible interval, 0.98-1.25).
Neighborhood socioeconomic disadvantage is associated with a higher disability burden in the 12 months after a critical illness. Future studies should evaluate barriers to functional recovery for ICU survivors living in disadvantaged neighborhoods.
社会经济地位低下的社区存在一些共同因素，如交通设施不足，可能会限制重症疾病幸存者获得康复护理服务的机会。我们的主要目标是评估社区社会经济劣势是否与重症疾病后残疾负担的增加有关。我们的次要目标是确定这种影响在出院到社区的患者和出院到医疗机构的患者之间是否存在差异。
具有链接医疗保险索赔数据的纵向队列研究。
美国。
199 名年龄较大的成年人，他们在 1998 年至 2017 年期间，在 13 项不同的功能任务中，每个月评估一次残疾情况，共 239 次 ICU 入院。
使用区域剥夺指数评估社区劣势，该指数对贫困、住房和就业指标进行 1-100 分的排名。与处于较有利社区的患者相比，处于劣势社区（得分最高的四分位数）的患者自我认定为非西班牙裔白人的可能性较低。在调整后的模型中，与处于较有利地区的患者相比，居住在劣势社区的老年患者在 ICU 出院后 12 个月内的残疾负担高出 9%（比率比，1.09；95%贝叶斯可信区间，1.02-1.16）。在调整出院目的地的二次分析中，社区劣势与 12 个月随访期间残疾负担增加 14%相关（比率比，1.14；95%可信区间，1.07-1.21）。与出院到医疗机构的患者相比，居住在劣势社区并出院回家的患者的残疾负担高出 10%，但这一差异无统计学意义（交互比率比，1.10；95%可信区间，0.98-1.25）。
社会经济地位低下的社区与重症疾病后 12 个月内更高的残疾负担相关。未来的研究应评估居住在劣势社区的 ICU 幸存者在功能恢复方面面临的障碍。
