Systematic racial differences exist in ICU admission among certain ethnicities

In a new study, researchers reported systematic racial differences in ICU admission patterns among patients with acute respiratory failure and sepsis who are Asian, Pacific Islander and Hispanic.

“In this study, we demonstrate that patients with acute respiratory failure and sepsis who are from certain minority racial and ethnic groups that might plausibly be managed in either the general ward or the ICU were more likely to receive initial ICU care than patients from nonminority groups,” Christopher F. Chesley, MD, MSCE, associate fellow in the division of pulmonary, allergy and critical care at the Palliative and Advanced Illness Research Center and the Leonard Davis Institute of Health Economics at the University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues wrote in Annals of the American Thoracic Society.

The retrospective cohort study included 84,685 adults with sepsis (61.1% white, 12.5% Black, 10.6% Asian/Pacific Islander, 10% Hispanic and 5.8% multiracial) and 42,008 adults with acute respiratory failure (61.5% white, 15.3% Black, 9.5% Asian/Pacific Islander, 8.1% Hispanic and 5.6% multiracial). Nearly one-quarter (23.8%) of adults had sepsis and acute respiratory failure. All patients were recruited from 27 hospitals across Philadelphia and Northern California from 2013 to 2018 and did not require life support at the time of hospitalization. Researchers developed a model of hospital-wide capacity strain to determine the relationships between patient race, ethnicity, ICU admission and capacity strain.

Compared with white patients, patients with sepsis (OR = 1.09; 95% CI, 1.03-1.16; P = .006) and/or acute respiratory failure (OR = 1.26; 95% CI, 1.16-1.37; P < .001) who were Asian/Pacific Islander had the highest odds of ICU admission after adjusting for demographics, disease severity and hospital. Researchers observed higher odds of ICU admission among patients with acute respiratory failure who were Hispanic (OR = 1.11; 95% CI, 1.02-1.21; P = .02).

The researchers reported there were no modified differences caused by capacity strain in ICU admission among patients who were Asian, Pacific Islander or Hispanic with sepsis or acute respiratory failure (P for all > .05).

“By quantifying hospital-wide capacity strain using a refined strain index, our study suggests that ICU admission was not restricted from patients who present for sepsis or acute respiratory failure and who identify as from racial and ethnic minority groups. Patients who identified as [non-Hispanic Asian and Pacific Islander] or Hispanic were independently more likely to be selected for critical care management when presenting for acute respiratory failure, while patients who identified as [non-Hispanic Asian and Pacific Islander] alone were also most likely to be initially admitted to ICUs when presenting for sepsis,” the researchers wrote. “... Future studies are needed to evaluate the equity of outcomes and processes related to intensive care delivery in light of these complex relationships.”