Alice Springs Hospital, Alice Springs, NT.
Monash University, Melbourne, VIC.
Med J Aust. 2023 Feb 6;218(2):77-83. doi: 10.5694/mja2.51763. Epub 2022 Oct 30.
To compare longer term (12-month) mortality outcomes for Indigenous and non-Indigenous people admitted to intensive care units (ICUs) in Australia.
DESIGN, SETTING, PARTICIPANTS: Retrospective registry-based data linkage cohort study; analysis of all admissions of adults (16 years or older) to Australian ICUs, 1 January 2017 - 31 December 2019, as recorded in the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD), linked using the SLK-581 key to National Death Index data.
Unadjusted and adjusted mortality risk, censored at twelve months from the start of index ICU admission. Secondary outcomes were unadjusted and adjusted mortality twelve months from admission to the ICU.
The APD recorded 330 712 eligible ICU admissions during 2017-2019 (65% of all ICU admissions registered), of which 11 322 were of Indigenous people (3.4%). Median age at admission was lower for Indigenous patients (51.2 [IQR, 36.7-63.6] years) than for non-Indigenous patients (66.5 [IQR, 52.7-76.1] years). Unadjusted mortality risk was similar for Indigenous and non-Indigenous patients (hazard ratio, 1.01; 95% CI, 0.97-1.06), but was higher for Indigenous patients after adjusting for age, admission diagnosis, illness severity, hospital type, jurisdiction, remoteness and socio-economic status (adjusted hazard ratio, 1.20; 95% CI, 1.14-1.27). Twelve-month mortality was higher for Indigenous than non-Indigenous patients (adjusted odds ratio, 1.24; 95% CI, 1.16-1.33).
Twelve-month mortality outcomes are poorer for people admitted to ICUs in Australia than for the general population. Further, after adjusting for age and other factors, survival outcomes are poorer for Indigenous than non-Indigenous people admitted to ICUs. Critical illness may therefore contribute to shorter life expectancy among Indigenous Australians.
比较澳大利亚重症监护病房（ICU）收治的原住民和非原住民患者的长期（12 个月）死亡率。
设计、设置、参与者：回顾性登记数据库链接队列研究；分析 2017 年 1 月 1 日至 2019 年 12 月 31 日期间澳大利亚 ICU 所有成人（16 岁及以上）入院的情况，这些数据记录在澳大利亚和新西兰重症监护学会（ANZICS）成人患者数据库（APD）中，使用 SLK-581 密钥与国家死亡指数数据链接。
从 ICU 入院开始的 12 个月时的未调整和调整后的死亡率，以 12 个月为截点。次要结局是 ICU 入院后 12 个月的未调整和调整死亡率。
APD 记录了 2017 年至 2019 年期间 330712 例符合条件的 ICU 入院（占所有 ICU 入院登记的 65%），其中 11322 例为原住民（3.4%）。入院时的中位年龄，原住民患者（51.2[IQR，36.7-63.6]岁）低于非原住民患者（66.5[IQR，52.7-76.1]岁）。未调整的死亡率在原住民和非原住民患者之间相似（危险比，1.01；95%CI，0.97-1.06），但在调整年龄、入院诊断、疾病严重程度、医院类型、司法管辖区、偏远程度和社会经济地位后，原住民患者的死亡率更高（调整后的危险比，1.20；95%CI，1.14-1.27）。12 个月死亡率，原住民患者高于非原住民患者（调整后的优势比，1.24；95%CI，1.16-1.33）。
澳大利亚 ICU 收治的患者 12 个月死亡率结果比一般人群更差。此外，在调整年龄和其他因素后，ICU 收治的原住民患者的生存结果比非原住民患者更差。因此，危重病可能导致澳大利亚原住民预期寿命缩短。
