McHenry Ryan D, Moultrie Christopher Ej, Corfield Alasdair R, Lone Nazir I, Mackay Daniel F, Pell Jill P
ScotSTAR, Scottish Ambulance Service, Paisley, UK.
Usher Institute, University of Edinburgh, Edinburgh, UK.
J Intensive Care Soc. 2025 May 14:17511437251338608. doi: 10.1177/17511437251338608.
Socioeconomic inequalities in chronic disease management and outcomes are well-established. Their association with critical illness management and outcomes is less clear. This study aimed to investigate the association between socioeconomic status and outcomes following emergency admission for critical illness.
Three Scotland-wide health databases were linked: the Scottish Intensive Care Society Audit Group database (critical care units); the Scottish Morbidity Record 01 (hospital admissions) and death certificates. A retrospective cohort study was conducted on adults (⩾16 years) admitted as an emergency to critical care units between 25th October 2010 and 25th October 2021 inclusive. Cox proportional hazards models were used to investigate the association between area-based socioeconomic status (Scottish Index of Mortality (SIMD) decile) and all-cause mortality, adjusting for potential confounders: age, sex, comorbidities, illness severity, and diagnostic group. Secondary outcomes included unit and hospital lengths of stay, and emergency hospital readmissions.
Overall, 50,914 patients were included in the cohort. Those in the least deprived decile were less likely to die (HR 0.85, 95% CI 0.79-0.92), had 19% longer critical care unit stays (95% CI 13-26) and a 12% longer hospital stays (95% CI 7%-18%). Over the subsequent year, the least deprived had significantly fewer emergency hospital re-admissions (IRR 0.73; 95% CI 0.67-0.81).
People living in the most deprived communities have worse outcomes following emergency admission to critical care; particularly in the longer term and reinforcing the need to address socioeconomic inequalities in healthcare access and outcomes.
慢性病管理及结局方面的社会经济不平等现象已得到充分证实。其与危重病管理及结局之间的关联尚不太明确。本研究旨在调查社会经济地位与危重病紧急入院后的结局之间的关联。
将三个全苏格兰范围的健康数据库进行了链接：苏格兰重症监护协会审计组数据库（重症监护病房）；苏格兰发病率记录01（医院入院情况）和死亡证明。对2010年10月25日至2021年10月25日期间（含）因紧急情况入住重症监护病房的成年人（≥16岁）进行了一项回顾性队列研究。使用Cox比例风险模型来研究基于地区的社会经济地位（苏格兰死亡率指数（SIMD）十分位数）与全因死亡率之间的关联，并对潜在混杂因素进行调整：年龄、性别、合并症、疾病严重程度和诊断组。次要结局包括在重症监护病房和医院的住院时间，以及急诊再入院情况。
总体而言，队列中纳入了50914名患者。处于最不贫困十分位数的患者死亡可能性较小（风险比0.85，95%置信区间0.79 - 0.92），在重症监护病房的住院时间长19%（95%置信区间13 - 26），在医院的住院时间长12%（95%置信区间7% - 18%）。在随后的一年中，最不贫困的患者急诊再入院的情况明显较少（发病率比0.73；95%置信区间0.67 - 0.81）。
生活在最贫困社区的人在紧急入住重症监护病房后的结局更差；特别是从长期来看，这凸显了解决医疗保健可及性和结局方面社会经济不平等问题的必要性。
