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. 2021 Feb:1:100005.
doi: 10.1016/j.lanepe.2020.100005. Epub 2020 Dec 15.

Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with COVID-19 to critical care units in Scotland: A national cohort study

Nazir I Lone  1   2 , Joanne McPeake  3 , Neil I Stewart  4 , Michael C Blayney  1   5 , Robert Chan Seem  5 , Lorraine Donaldson  5 , Elaine Glass  6 , Catriona Haddow  5 , Ros Hall  5 , Caroline Martin  5 , Martin Paton  5 , Alison Smith-Palmer  5 , Callum T Kaye  7 , Kathryn Puxty  3 ; Scottish Intensive Care Society Audit Group
Affiliations

Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with COVID-19 to critical care units in Scotland: A national cohort study

Nazir I Lone et al. Lancet Reg Health Eur. 2021 Feb.

Abstract

Background: Coronavirus disease 2019 (COVID-19) can lead to significant respiratory failure with between 14% and 18% of hospitalised patients requiring critical care admission. This study describes the impact of socioeconomic deprivation on 30-day survival following critical care admission for COVID-19, and the impact of the COVID-19 pandemic on critical care capacity in Scotland.

Methods: This cohort study used linked national hospital records including ICU, virology testing and national death records to identify and describe patients with COVID-19 admitted to critical care units in Scotland. Multivariable logistic regression was used to assess the impact of deprivation on 30-day mortality. Critical care capacity was described by reporting the percentage of baseline ICU bed utilisation required.

Findings: There were 735 patients with COVID-19 admitted to critical care units across Scotland from 1/3/2020 to 20/6/2020. There was a higher proportion of patients from more deprived areas, with 183 admissions (24.9%) from the most deprived quintile and 100 (13.6%) from the least deprived quintile. Overall, 30-day mortality was 34.8%. After adjusting for age, sex and ethnicity, mortality was significantly higher in patients from the most deprived quintile (OR 1.97, 95%CI 1.13, 3.41, p=0.016). ICUs serving populations with higher levels of deprivation spent a greater amount of time over their baseline ICU bed capacity.

Interpretation: Patients with COVID-19 living in areas with greatest socioeconomic deprivation had a higher frequency of critical care admission and a higher adjusted 30-day mortality. ICUs in health boards with higher levels of socioeconomic deprivation had both higher peak occupancy and longer duration of occupancy over normal maximum capacity.

Funding: None.

Keywords: COVID-19; Intensive care; Mortality; Social deprivation.

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Conflict of interest statement

All authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; NL is Director of Research, Intensive Care Society; JM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019-02-16). The funder had no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication.

Figures

Fig 1
Fig. 1
Cumulative frequency of patients with COVID-19 admitted to critical care units stratified by socioeconomic deprivation quintile.
Fig 2
Fig. 2
Daily frequency of critical care bed occupancy stratified by socioeconomic deprivation quintile and organ support. Bed occupancy is derived from Augmented Care Period (ACP) days. See text for explanation of levels of care. Abbreviations: SIMD, Scottish Index of Multiple Deprivation; RRT, renal replacement therapy; NIRS, non-invasive respiratory support; Adv Res, advanced respiratory.
Fig 3
Fig. 3
Activity in intensive care units as a proportion of baseline funded level 3 capacity for Scotland, and stratified by health boards grouped by levels of socioeconomic deprivation.
See this image and copyright information in PMC

References

    1. Docherty AB, Harrison EM, Green AG. Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study. Br Med J. 2020;369:m1985. - PMC - PubMed
    1. UK Government (2020) Coronavirus (COVID-19) in the UK. Accessed 7th of November 2020 https://coronavirus.data.gov.uk/details/deaths.
    1. Richardson S., Hirsch JS., Narasimhan DO. Presenting characteristic, co-morbidities and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. J Am Med Ass. 2020;323(20):2052–2059. - PMC - PubMed
    1. Karaglannidis C., Mostert C., Hentschker C. Case characteristics, resource use and outcomes of 10021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med. 2020 doi: 10.1016/S2213-2600(20)30316-7. published early online: Published Online July 28, 2020. - DOI - PMC - PubMed
    1. Intensive Care National Audit and Research Centre (2020) ICNARC report on COVID-19 in critical care. 31st of July 2020. Accessed 7th of November: https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports