Research Fellow, Medical Research Institute of New Zealand, Wellington.
Statistician. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Statistician University of Melbourne, Parkville, Victoria, Australia.
N Z Med J. 2022 Feb 25;135(1550):26-46.
To describe characteristics and outcomes of Māori and European patients admitted to New Zealand intensive care units (ICUs) between 2009 and 2018.
A retrospectively designed prospective cohort study. New Zealand Ministry of Health National Minimum Dataset matched to the Australia New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database. The primary outcome was day-180 mortality. Secondary outcomes were ICU mortality, hospital mortality, discharge to home, ICU length of stay, hospital length of stay and survival time. We report associations between Māori ethnicity and each outcome, with European as the reference category, using regression analyses to adjust sequentially for site, deprivation status, sex, year of admission, the Charlson comorbidity index, age, admission source and type, ICU admission diagnosis, ventilation status and illness severity based on physiological parameters.
Māori admitted to ICU were on average 13 years younger than European patients. A total of 968 of 9,681 (10%) Māori and 2,732 of 42,871 (5.2%) European patients were admitted after trauma, and 740 of 9,681 (7.6%) and 2,318 of 42,871 (4.4%) were admitted with sepsis respectively. A total of 1,550 of 9,681 (16.0%) Māori and 6,407 of 42,871 (14.9%) European patients died within 180 days of ICU admission; odds ratio (OR) 1.08; 95% CI, 1.02 to 1.15. When adjusted for age, the OR for day-180 mortality for Māori versus European patients increased substantially. The OR decreased after adjustment for admission source and type, and after accounting for Māori having a higher comorbidity index and more severe illness than European patients. In the final model, incorporating adjustment for all specified variables, Māori ethnicity was not associated with day-180 mortality (adjusted OR 1.01; 95%CI, 0.92 to 1.10). Findings were similar for all secondary outcomes.
Compared to European patients, Māori were markedly more likely to be admitted to the ICU after trauma or with sepsis. Despite Māori being on average 13 years younger at ICU admission than their European counterparts, they had more co-morbidities, higher illness severity and a higher risk of dying within 180 days.
描述 2009 年至 2018 年间在新西兰重症监护病房（ICU）住院的毛利人和欧洲患者的特征和结局。
这是一项回顾性设计的前瞻性队列研究。新西兰卫生部国家最低数据集与澳大利亚和新西兰重症监护学会中心的结果和资源评估成人患者数据库相匹配。主要结局是 180 天死亡率。次要结局是 ICU 死亡率、医院死亡率、出院回家、ICU 住院时间、医院住院时间和生存时间。我们报告了毛利人种族与每种结局之间的关联，以欧洲人为参考类别，使用回归分析依次调整地点、贫困状况、性别、入院年份、Charlson 合并症指数、年龄、入院来源和类型、ICU 入院诊断、通气状态和基于生理参数的疾病严重程度。
入住 ICU 的毛利人比欧洲人平均年轻 13 岁。在总共 968 名毛利人和 2732 名欧洲人中，有 10%的人因创伤而入住 ICU，分别有 740 名毛利人和 2318 名欧洲人因败血症而入住 ICU。9681 名毛利人中有 1550 人（16.0%）和 42871 名欧洲人（14.9%）在 ICU 入院后 180 天内死亡；优势比（OR）为 1.08；95%CI，1.02 至 1.15。当调整年龄时，毛利人与欧洲人第 180 天死亡率的 OR 显著增加。调整入院来源和类型后，OR 下降，且毛利人比欧洲人合并症指数更高，疾病更严重。在最终模型中，纳入所有指定变量的调整后，毛利人种族与第 180 天死亡率无关（调整后的 OR 为 1.01；95%CI，0.92 至 1.10）。所有次要结局的结果均相似。
与欧洲患者相比，毛利人因创伤或败血症更有可能入住 ICU。尽管毛利人在 ICU 入院时比欧洲人平均年轻 13 岁，但他们的合并症更多，疾病严重程度更高，180 天内死亡的风险更高。
