Temporal Trends in Critical Care Outcomes in U.S. Minority-Serving Hospitals

• Published in: American journal of respiratory and critical care medicine 2020-03, Vol.201 (6), p.681-687
• Main Authors: Danziger, John, Ángel Armengol de la Hoz, Miguel, Li, Wenyuan, Komorowski, Matthieu, Deliberato, Rodrigo Octávio, Rush, Barret N M, Mukamal, Kenneth J, Celi, Leo, Badawi, Omar
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Black or African American - statistics & numerical data; Critical care; Critical Care - statistics & numerical data; Critical Care - trends; Critical Care Outcomes; Female; Health care; Hispanic or Latino - statistics & numerical data; Hospitalists; Hospitals - statistics & numerical data; Hospitals - trends; Humans; Male; Middle Aged; Minority & ethnic groups; Minority Groups - statistics & numerical data; Original; United States; White People - statistics & numerical data
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201903-0623OC

Whether critical care improvements over the last 10 years extend to all hospitals has not been described. To examine the temporal trends of critical care outcomes in minority and non-minority-serving hospitals using an inception cohort of critically ill patients. Using the Philips Health Care electronic ICU Research Institute Database, we identified minority-serving hospitals as those with an African American or Hispanic ICU census more than twice its regional mean. We examined almost 1.1 million critical illness admissions among 208 ICUs from across the United States admitted between 2006 and 2016. Adjusted hospital mortality (primary) and length of hospitalization (secondary) were the main outcomes. Large pluralities of African American (25%,  = 27,242) and Hispanic individuals (48%,  = 26,743) were cared for in minority-serving hospitals, compared with only 5.2% (  = 42,941) of white individuals. Over the last 10 years, although the risk of critical illness mortality steadily decreased by 2% per year (95% confidence interval [CI], 0.97-0.98) in non-minority-serving hospitals, outcomes within minority-serving hospitals did not improve comparably. This disparity in temporal trends was particularly noticeable among African American individuals, where each additional calendar year was associated with a 3% (95% CI, 0.96-0.97) lower adjusted critical illness mortality within a non-minority-serving hospital, but no change within minority-serving hospitals (hazard ratio, 0.99; 95% CI, 0.97-1.01). Similarly, although ICU and hospital lengths of stay decreased by 0.08 (95% CI, -0.08 to -0.07) and 0.16 (95% CI, -0.16 to -0.15) days per additional calendar year, respectively, in non-minority-serving hospitals, there was little temporal change for African American individuals in minority-serving hospitals. Critically ill African American individuals are disproportionately cared for in minority-serving hospitals, which have shown significantly less improvement than non-minority-serving hospitals over the last 10 years.