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. 2022 May 1;50(5):733-741.
doi: 10.1097/CCM.0000000000005364. Epub 2021 Oct 12.

Neighborhood Socioeconomic Disadvantage and Disability After Critical Illness

Jason R Falvey  1 , Terrence E Murphy  2 , Linda Leo-Summers  2 , Thomas M Gill  2 , Lauren E Ferrante  2
Affiliations

Neighborhood Socioeconomic Disadvantage and Disability After Critical Illness

Jason R Falvey et al. Crit Care Med. .

Abstract

Objectives: Factors common to socioeconomically disadvantaged neighborhoods, such as low availability of transportation, may limit access to restorative care services for critical illness survivors. Our primary objective was to evaluate whether neighborhood socioeconomic disadvantage was associated with an increased disability burden after critical illness. Our secondary objective was to determine if the effect differed for those discharged to the community compared with those discharged to a facility.

Design: Longitudinal cohort study with linked Medicare claims data.

Setting: United States.

Patients: One hundred ninety-nine older adults, contributing to 239 ICU admissions, who underwent monthly assessments of disability for 12 months following hospital discharge in 13 different functional tasks from 1998 to 2017.

Measurements and main results: Neighborhood disadvantage was assessed using the area deprivation index, a 1-100 ranking evaluating poverty, housing, and employment metrics. Those living in disadvantaged neighborhoods (top quartile of scores) were less likely to self-identify as non-Hispanic White compared with those in more advantaged neighborhoods. In adjusted models, older adults living in disadvantaged neighborhoods had a 9% higher disability burden over the 12 months following ICU discharge compared with those in more advantaged areas (rate ratio, 1.09; 95% Bayesian credible interval, 1.02-1.16). In the secondary analysis adjusting for discharge destination, neighborhood disadvantage was associated with a 14% increase in disability burden over 12 months of follow-up (rate ratio, 1.14; 95% credible interval, 1.07-1.21). Disability burden was 10% higher for those living in disadvantaged neighborhoods and discharged home as compared with those discharged to a facility, but this difference was not statistically significant (interaction rate ratio, 1.10; 95% credible interval, 0.98-1.25).

Conclusions: Neighborhood socioeconomic disadvantage is associated with a higher disability burden in the 12 months after a critical illness. Future studies should evaluate barriers to functional recovery for ICU survivors living in disadvantaged neighborhoods.

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Conflict of interest statement

Dr. Falvey received grant support from a Foundation for Physical Therapy Research Pipeline to Health Services Research Grant, a National Institute on Aging (NIA) training grant T32AG019134, and from the University of Maryland Claude D. Pepper Older Americans Independence Center (P30AG028747). Dr. Murphy is supported by the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Dr. Ferrante is supported by a Paul B. Beeson Emerging Leaders Career Development Award in Aging from the NIA (K76AG057023) and the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. Dr. Falvey’s institution received support for article research from the Foundation for Physical Therapy Research. Drs. Falvey’s, Murphy’s, Gill’s, and Ferrante’s institutions received funding from the National Institutes on Aging (NIA). Drs. Falvey, Murphy, Gill, and Ferrante received support for article research from the National Institutes of Health. Dr. Leo-Summers received support for article research from the NIA.

Figures

Figure 1:
Figure 1:
Assembly of analytic samples from the parent cohort. All patient-ICU admissions from study enrollment through December 2017 were identified. For the primary outcome of post-ICU disability count, the analytic sample included 239 ICU admissions contributed by participants who survived to the first post-ICU monthly interview and were not discharged to hospice.
Figure 2:
Figure 2:
Pre-and post-ICU disability count by neighborhood socioeconomic disadvantage. Data presented over 12 months of post-ICU follow-up for all patient-ICU admissions (n=239). Values (ranging from 0 to 13) are unadjusted and error bars represent 95% confidence intervals. As a reference point, the pre-ICU disability counts (from the month prior to ICU admission) are included at month 0.
See this image and copyright information in PMC

Comment in

References

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