Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up
The aim of this study was to examine relationships between education, income, and employment (socioeconomic status, SES) and intensive care unit (ICU) survival and survival 1 year after discharge from ICU (Post-ICU survival). Individual data from ICU patients were linked to register data of educatio...
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Published in: | Journal of critical care 2024-04, Vol.80, p.154497, Article 154497 |
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description | The aim of this study was to examine relationships between education, income, and employment (socioeconomic status, SES) and intensive care unit (ICU) survival and survival 1 year after discharge from ICU (Post-ICU survival).
Individual data from ICU patients were linked to register data of education level, disposable income, employment status, civil status, foreign background, comorbidities, and vital status. Associations between SES, ICU survival and 1-year post-ICU survival was analysed using Cox's regression.
We included 58,279 adults (59% men, median length of stay in ICU 4.0 days, median SAPS3 score 61). Survival rates at discharge from ICU and one year after discharge were 88% and 63%, respectively. Risk of ICU death (Hazard ratios, HR) was significantly higher in unemployed and retired compared to patients who worked prior to admission (1.20; 95% CI: 1.10-1.30 and 1.15; (1.07-1.24), respectively. There was no consistent association between education, income and ICU death. Risk of post-ICU death decreased with greater income and was roughly 16% lower in the highest compared to lowest income quintile (HR 0.84; 0.79-0.88). Higher education levels appeared to be associated with reduced risk of death during the first year after ICU discharge.
Significant relationships between low SES in the critically ill and increased risk of death indicate that it is important to identify and support patients with low SES to improve survival after intensive care. Studies of survival after critical illness need to account for participants SES. |
doi_str_mv | 10.1016/j.jcrc.2023.154497 |
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Individual data from ICU patients were linked to register data of education level, disposable income, employment status, civil status, foreign background, comorbidities, and vital status. Associations between SES, ICU survival and 1-year post-ICU survival was analysed using Cox's regression.
We included 58,279 adults (59% men, median length of stay in ICU 4.0 days, median SAPS3 score 61). Survival rates at discharge from ICU and one year after discharge were 88% and 63%, respectively. Risk of ICU death (Hazard ratios, HR) was significantly higher in unemployed and retired compared to patients who worked prior to admission (1.20; 95% CI: 1.10-1.30 and 1.15; (1.07-1.24), respectively. There was no consistent association between education, income and ICU death. Risk of post-ICU death decreased with greater income and was roughly 16% lower in the highest compared to lowest income quintile (HR 0.84; 0.79-0.88). Higher education levels appeared to be associated with reduced risk of death during the first year after ICU discharge.
Significant relationships between low SES in the critically ill and increased risk of death indicate that it is important to identify and support patients with low SES to improve survival after intensive care. Studies of survival after critical illness need to account for participants SES.</description><identifier>ISSN: 0883-9441</identifier><identifier>ISSN: 1557-8615</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2023.154497</identifier><identifier>PMID: 38086226</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Adult ; Age ; Cohort analysis ; Cohort Studies ; Comorbidity ; Disposable income ; Education ; Educational Status ; Employment ; Female ; Follow-Up Studies ; Humans ; Illnesses ; Intensive care ; Intensive Care Units ; Length of stay ; Male ; Mortality ; Ostomy ; Patients ; Quality standards ; Socioeconomic factors ; Socioeconomic status ; Sweden - epidemiology ; Systematic review</subject><ispartof>Journal of critical care, 2024-04, Vol.80, p.154497, Article 154497</ispartof><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c320t-6c92a6bf150eac0f72bc26e1c9c63abbc8e9e56c076054ba809bf9b9b9a100c83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38086226$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-200354$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Orwelius, Lotti</creatorcontrib><creatorcontrib>Kristenson, Margareta</creatorcontrib><creatorcontrib>Fredrikson, Mats</creatorcontrib><creatorcontrib>Sjöberg, Folke</creatorcontrib><creatorcontrib>Walther, Sten</creatorcontrib><title>Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>The aim of this study was to examine relationships between education, income, and employment (socioeconomic status, SES) and intensive care unit (ICU) survival and survival 1 year after discharge from ICU (Post-ICU survival).
Individual data from ICU patients were linked to register data of education level, disposable income, employment status, civil status, foreign background, comorbidities, and vital status. Associations between SES, ICU survival and 1-year post-ICU survival was analysed using Cox's regression.
We included 58,279 adults (59% men, median length of stay in ICU 4.0 days, median SAPS3 score 61). Survival rates at discharge from ICU and one year after discharge were 88% and 63%, respectively. Risk of ICU death (Hazard ratios, HR) was significantly higher in unemployed and retired compared to patients who worked prior to admission (1.20; 95% CI: 1.10-1.30 and 1.15; (1.07-1.24), respectively. There was no consistent association between education, income and ICU death. Risk of post-ICU death decreased with greater income and was roughly 16% lower in the highest compared to lowest income quintile (HR 0.84; 0.79-0.88). Higher education levels appeared to be associated with reduced risk of death during the first year after ICU discharge.
Significant relationships between low SES in the critically ill and increased risk of death indicate that it is important to identify and support patients with low SES to improve survival after intensive care. Studies of survival after critical illness need to account for participants SES.</description><subject>Adult</subject><subject>Age</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Disposable income</subject><subject>Education</subject><subject>Educational Status</subject><subject>Employment</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Length of stay</subject><subject>Male</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Quality standards</subject><subject>Socioeconomic factors</subject><subject>Socioeconomic status</subject><subject>Sweden - epidemiology</subject><subject>Systematic review</subject><issn>0883-9441</issn><issn>1557-8615</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdkc1u1DAURi0EotPCC7BAltiwIIPtxE6yHE1LqVSJBZSt5Tg3jCMnDv6ZaJ6FlyXplC6QF5at833X1kHoHSVbSqj43G977fWWEZZvKS-KunyBNpTzMqsE5S_RhlRVntVFQS_QZQg9IbTMc_4aXeQVqQRjYoP-3HQd6Biw6zC0Sato3PgJm1G7AbAaWwzDZN1pgDFiN-K7_cPj7eRCzNZDSP5ojsriDO_w-BifTQv4-wytCQes3cH5iENM7WkdYsbWHE2blM0sHMHiVkWFZxMPmGYnUB53zlo34zS9Qa86ZQO8fdqv0MOXmx_7r9n9t9u7_e4-0zkjMRO6Zko0HeUElCZdyRrNBFBda5GrptEV1MCFJqUgvGhUReqmq5tlKUqIrvIrlJ17wwxTauTkzaD8STpl5LX5uZPO_5LWJMkIyXmx8B_P_OTd7wQhysEEDdaqEVwKktWE1bzkxVr94T-0d8mPy28WioqCipKLhWJnSnsXgofu-QmUyFW17OWqWq6q5Vn1Enr_VJ2aAdrnyD-3-V_MoacQ</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Orwelius, Lotti</creator><creator>Kristenson, Margareta</creator><creator>Fredrikson, Mats</creator><creator>Sjöberg, Folke</creator><creator>Walther, Sten</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DG8</scope></search><sort><creationdate>20240401</creationdate><title>Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up</title><author>Orwelius, Lotti ; Kristenson, Margareta ; Fredrikson, Mats ; Sjöberg, Folke ; Walther, Sten</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c320t-6c92a6bf150eac0f72bc26e1c9c63abbc8e9e56c076054ba809bf9b9b9a100c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Age</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Disposable income</topic><topic>Education</topic><topic>Educational Status</topic><topic>Employment</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Length of stay</topic><topic>Male</topic><topic>Mortality</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Quality standards</topic><topic>Socioeconomic factors</topic><topic>Socioeconomic status</topic><topic>Sweden - epidemiology</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Orwelius, Lotti</creatorcontrib><creatorcontrib>Kristenson, Margareta</creatorcontrib><creatorcontrib>Fredrikson, Mats</creatorcontrib><creatorcontrib>Sjöberg, Folke</creatorcontrib><creatorcontrib>Walther, Sten</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Linköpings universitet</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Orwelius, Lotti</au><au>Kristenson, Margareta</au><au>Fredrikson, Mats</au><au>Sjöberg, Folke</au><au>Walther, Sten</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>80</volume><spage>154497</spage><pages>154497-</pages><artnum>154497</artnum><issn>0883-9441</issn><issn>1557-8615</issn><eissn>1557-8615</eissn><abstract>The aim of this study was to examine relationships between education, income, and employment (socioeconomic status, SES) and intensive care unit (ICU) survival and survival 1 year after discharge from ICU (Post-ICU survival).
Individual data from ICU patients were linked to register data of education level, disposable income, employment status, civil status, foreign background, comorbidities, and vital status. Associations between SES, ICU survival and 1-year post-ICU survival was analysed using Cox's regression.
We included 58,279 adults (59% men, median length of stay in ICU 4.0 days, median SAPS3 score 61). Survival rates at discharge from ICU and one year after discharge were 88% and 63%, respectively. Risk of ICU death (Hazard ratios, HR) was significantly higher in unemployed and retired compared to patients who worked prior to admission (1.20; 95% CI: 1.10-1.30 and 1.15; (1.07-1.24), respectively. There was no consistent association between education, income and ICU death. Risk of post-ICU death decreased with greater income and was roughly 16% lower in the highest compared to lowest income quintile (HR 0.84; 0.79-0.88). Higher education levels appeared to be associated with reduced risk of death during the first year after ICU discharge.
Significant relationships between low SES in the critically ill and increased risk of death indicate that it is important to identify and support patients with low SES to improve survival after intensive care. Studies of survival after critical illness need to account for participants SES.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>38086226</pmid><doi>10.1016/j.jcrc.2023.154497</doi></addata></record> |
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subjects | Adult Age Cohort analysis Cohort Studies Comorbidity Disposable income Education Educational Status Employment Female Follow-Up Studies Humans Illnesses Intensive care Intensive Care Units Length of stay Male Mortality Ostomy Patients Quality standards Socioeconomic factors Socioeconomic status Sweden - epidemiology Systematic review |
title | Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up |
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