Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Department of Critical Care, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, OH, 44195, Cleveland, USA.
J Racial Ethn Health Disparities. 2023 Apr;10(2):660-670. doi: 10.1007/s40615-022-01254-1. Epub 2022 Feb 4.
US racial and ethnic minorities have well-established elevated rates of comorbidities, which, compounded with healthcare access inequity, often lead to worse health outcomes. In the current COVID-19 pandemic, it is important to understand existing disparities in minority groups' critical care outcomes and mechanisms behind these-topics that have yet to be well-explored.
Assess for disparities in racial and ethnic minority groups' COVID-19 critical care outcomes.
Retrospective cohort study.
A total of 2125 adult patients who tested positive for COVID-19 via RT-PCR between March and December 2020 and required ICU admission at the Cleveland Clinic Hospital Systems were included.
Primary outcomes were mortality and hospital length of stay. Cohort-wide analysis and subgroup analyses by pandemic wave were performed. Multivariable logistic regression models were built to study the associations between mortality and covariates.
While crude mortality was increased in White as compared to Black patients (37.5% vs. 30.5%, respectively; p = 0.002), no significant differences were appraised after adjustment or across pandemic waves. Although median hospital length of stay was comparable between these groups, ICU stay was significantly different (4.4 vs. 3.4, p = 0.003). Mortality and median hospital and ICU length of stay did not differ significantly between Hispanic and non-Hispanic patients. Neither race nor ethnicity was associated with mortality due to COVID-19, although APACHE score, CKD, malignant neoplasms, antibiotic use, vasopressor requirement, and age were.
We found no significant differences in mortality or hospital length of stay between different races and ethnicities. In a pandemic-influenced critical care setting that operated outside conditions of ICU strain and implemented standardized protocol enabling equitable resource distribution, disparities in outcomes often seen among racial and ethnic minority groups were successfully mitigated.
美国的少数族裔存在着既定的、更高的合并症发病率，再加上医疗保健获取的不平等，往往导致更差的健康结果。在当前的 COVID-19 大流行中，了解少数群体在重症监护方面的结果差异以及这些问题背后的机制非常重要——这些问题尚未得到充分探讨。
评估少数族裔在 COVID-19 重症监护方面的结果差异。
回顾性队列研究。
总共纳入了 2125 名在 2020 年 3 月至 12 月期间通过 RT-PCR 检测出 COVID-19 呈阳性并需要在克利夫兰诊所医院系统接受 ICU 治疗的成年患者。
主要结果是死亡率和住院时间。进行了全队列分析和按大流行波次的亚组分析。建立了多变量逻辑回归模型，以研究死亡率与协变量之间的关系。
虽然与黑人患者相比，白人患者的死亡率更高（分别为 37.5%和 30.5%；p=0.002），但在调整后或整个大流行波次中，差异无统计学意义。尽管这些组之间的中位住院时间相似，但 ICU 住院时间有显著差异（4.4 与 3.4，p=0.003）。西班牙裔和非西班牙裔患者之间的死亡率和中位住院及 ICU 住院时间无显著差异。种族或民族均与 COVID-19 死亡率无关，尽管 APACHE 评分、CKD、恶性肿瘤、抗生素使用、血管加压素需求和年龄与死亡率相关。
我们发现不同种族和民族之间的死亡率或住院时间无显著差异。在一个大流行影响的重症监护环境中，该环境在 ICU 紧张的情况下运作，并实施了标准化协议，以公平分配资源，成功减轻了少数族裔群体中经常出现的结果差异。
