The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID‐19 pandemic

• Published in: Health services research 2022-12, Vol.57 (S2), p.279-290
• Main Authors: Levinson, Zachary, Cantor, Jonathan, Williams, Malcolm V., Whaley, Christopher
• Format: Article
• Language: English
• Subjects: acute inpatient care; Aged; Allocations; Bivariate analysis; Certification; Composition; COVID-19; Cross-Sectional Studies; Data collection; Discrimination in medical care; Evaluation; health care disparities; health care financing/insurance/premiums; health policy/politics/law/regulation; Hospital Bed Capacity; Hospital costs; Hospital size; Hospitals; Humans; Intensive care; Intensive Care Units; Medical care discrimination; Medical referrals; Medicare; Occupancy; Pandemics; Patients; Prevention; Statistical analysis; United States
• ISSN: 0017-9124; 1475-6773; 1475-6773
• DOI: 10.1111/1475-6773.14028

Objective To identify the association between strained intensive care unit (ICU) capacity during the COVID‐19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics. Data Sources We used government data on hospital capacity during the pandemic and Provider Relief Fund (PRF) allocations, Medicare claims and enrollment data, hospital cost reports, and Social Vulnerability Index data. Study Design We conducted cross‐sectional bivariate analyses relating strained capacity and PRF award per hospital bed with hospital patient composition and other characteristics, with and without adjustment for hospital referral region (HRR). Data Collection We linked PRF data to CMS Certification Numbers based on hospital name and location. We used measures of racial and ethnic composition generated from Medicare claims and enrollment data. Our sample period includes the weeks of September 18, 2020 through November 5, 2021, and we restricted our analysis to short‐term, general hospitals with at least one intensive care unit (ICU) bed. We defined “ICU strain share” as the proportion of ICU days occurring while a given hospital had an ICU occupancy rate ≥ 90%. Principal Findings After adjusting for HRR, hospitals in the top tercile of Black patient shares had higher ICU strain shares than did hospitals in the bottom tercile (30% vs. 22%, p