Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study
Abstract Background The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. Methods Prospective multicenter cohort study conducted from March to June 2018 in eigh...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2024-04-01
|
| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-024-01279-1 |
| _version_ | 1827284070903578624 |
|---|---|
| author | Morgan Benaïs Matthieu Duprey Laura Federici Michel Arnaout Pierre Mora Marc Amouretti Irma Bourgeon-Ghittori Stéphane Gaudry Pierre Garçon Danielle Reuter Guillaume Geri Bruno Megarbane Jordane Lebut Armand Mekontso-Dessap Jean-Damien Ricard Daniel da Silva Etienne de Montmollin |
| author_facet | Morgan Benaïs Matthieu Duprey Laura Federici Michel Arnaout Pierre Mora Marc Amouretti Irma Bourgeon-Ghittori Stéphane Gaudry Pierre Garçon Danielle Reuter Guillaume Geri Bruno Megarbane Jordane Lebut Armand Mekontso-Dessap Jean-Damien Ricard Daniel da Silva Etienne de Montmollin |
| author_sort | Morgan Benaïs |
| collection | DOAJ |
| description | Abstract Background The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. Methods Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18 years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. Results A total of 1,748 patients were included. Median age was 62.9 [47.4–74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1–6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1–2] deprivations and all had housing deprivation, phenotype D patients had 2 [1–2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2–4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65–1.12); phenotype C (HR, 0.56; 95% CI 0.34–0.93); phenotype D (HR, 1.09; 95% CI 0.78–1.51); phenotype E (HR, 1.20; 95% CI 0.73–1.96). Conclusions In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions. |
| first_indexed | 2024-04-24T09:48:55Z |
| format | Article |
| id | doaj.art-88df0ee5c6004c67a662ea06e4212398 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-24T09:48:55Z |
| publishDate | 2024-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-88df0ee5c6004c67a662ea06e42123982024-04-14T11:29:15ZengSpringerOpenAnnals of Intensive Care2110-58202024-04-0114111110.1186/s13613-024-01279-1Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort studyMorgan Benaïs0Matthieu Duprey1Laura Federici2Michel Arnaout3Pierre Mora4Marc Amouretti5Irma Bourgeon-Ghittori6Stéphane Gaudry7Pierre Garçon8Danielle Reuter9Guillaume Geri10Bruno Megarbane11Jordane Lebut12Armand Mekontso-Dessap13Jean-Damien Ricard14Daniel da Silva15Etienne de Montmollin16Service de Médecine Intensive - Réanimation, Hôpital DelafontaineService de Réanimation, Grand Hôpital de l’Est Francilien-Site de Marne-la-ValléeService de Réanimation Polyvalente, Centre Hospitalier Sud FrancilienService de Médecine Intensive - Réanimation, AP-HP, Hôpital Ambroise ParéService de Médecine Intensive - Réanimation, AP-HP, Hôpital LariboisièreService de Réanimation Polyvalente, Groupe Hospitalier Nord-EssonneService de Médecine Intensive - Réanimation, AP-HP, Hôpital Henri MondorDMU ESPRIT, Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Louis MourierService de Réanimation, Grand Hôpital de l’Est Francilien-Site de Marne-la-ValléeService de Réanimation Polyvalente, Centre Hospitalier Sud FrancilienService de Médecine Intensive - Réanimation, AP-HP, Hôpital Ambroise ParéService de Médecine Intensive - Réanimation, AP-HP, Hôpital LariboisièreService de Réanimation Polyvalente, Groupe Hospitalier Nord-EssonneService de Médecine Intensive - Réanimation, AP-HP, Hôpital Henri MondorDMU ESPRIT, Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Louis MourierService de Médecine Intensive - Réanimation, Hôpital DelafontaineService de Médecine Intensive - Réanimation, Hôpital DelafontaineAbstract Background The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. Methods Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18 years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. Results A total of 1,748 patients were included. Median age was 62.9 [47.4–74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1–6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1–2] deprivations and all had housing deprivation, phenotype D patients had 2 [1–2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2–4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65–1.12); phenotype C (HR, 0.56; 95% CI 0.34–0.93); phenotype D (HR, 1.09; 95% CI 0.78–1.51); phenotype E (HR, 1.20; 95% CI 0.73–1.96). Conclusions In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions.https://doi.org/10.1186/s13613-024-01279-1Social deprivationSocioeconomic factorSocioeconomic statusCritical illnessIntensive care units |
| spellingShingle | Morgan Benaïs Matthieu Duprey Laura Federici Michel Arnaout Pierre Mora Marc Amouretti Irma Bourgeon-Ghittori Stéphane Gaudry Pierre Garçon Danielle Reuter Guillaume Geri Bruno Megarbane Jordane Lebut Armand Mekontso-Dessap Jean-Damien Ricard Daniel da Silva Etienne de Montmollin Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study Annals of Intensive Care Social deprivation Socioeconomic factor Socioeconomic status Critical illness Intensive care units |
| title | Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study |
| title_full | Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study |
| title_fullStr | Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study |
| title_full_unstemmed | Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study |
| title_short | Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study |
| title_sort | association of socioeconomic deprivation with outcomes in critically ill adult patients an observational prospective multicenter cohort study |
| topic | Social deprivation Socioeconomic factor Socioeconomic status Critical illness Intensive care units |
| url | https://doi.org/10.1186/s13613-024-01279-1 |
| work_keys_str_mv | AT morganbenais associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT matthieuduprey associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT laurafederici associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT michelarnaout associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT pierremora associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT marcamouretti associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT irmabourgeonghittori associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT stephanegaudry associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT pierregarcon associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT daniellereuter associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT guillaumegeri associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT brunomegarbane associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT jordanelebut associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT armandmekontsodessap associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT jeandamienricard associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT danieldasilva associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy AT etiennedemontmollin associationofsocioeconomicdeprivationwithoutcomesincriticallyilladultpatientsanobservationalprospectivemulticentercohortstudy |