Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with COVID-19 to critical care units in Scotland: a national cohort study

Lone, N. I. et al. (2021) Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with COVID-19 to critical care units in Scotland: a national cohort study. Lancet Regional Health - Europe, 1, 100005. (doi: 10.1016/j.lanepe.2020.100005) (PMCID:PMC7834626)

Abstract

Background: Coronavirus disease 2019 (COVID-19) can lead to significant respiratory failure with between 14% and 18% of hospitalised patients requiring critical care admission. This study describes the impact of socioeconomic deprivation on 30-day survival following critical care admission for COVID-19, and the impact of the COVID-19 pandemic on critical care capacity in Scotland. Methods: This cohort study used linked national hospital records including ICU, virology testing and national death records to identify and describe patients with COVID-19 admitted to critical care units in Scotland. Multivariable logistic regression was used to assess the impact of deprivation on 30-day mortality. Critical care capacity was described by reporting the percentage of baseline ICU bed utilisation required. Findings: There were 735 patients with COVID-19 admitted to critical care units across Scotland from 1/3/2020 to 20/6/2020. There was a higher proportion of patients from more deprived areas, with 183 admissions (24.9%) from the most deprived quintile and 100 (13.6%) from the least deprived quintile. Overall, 30-day mortality was 34.8%. After adjusting for age, sex and ethnicity, mortality was significantly higher in patients from the most deprived quintile (OR 1.97, 95%CI 1.13, 3.41, p=0.016). ICUs serving populations with higher levels of deprivation spent a greater amount of time over their baseline ICU bed capacity. Interpretation: Patients with COVID-19 living in areas with greatest socioeconomic deprivation had a higher frequency of critical care admission and a higher adjusted 30-day mortality. ICUs in health boards with higher levels of socioeconomic deprivation had both higher peak occupancy and longer duration of occupancy over normal maximum capacity. Funding: None.

• Item Type: Articles
• Additional Information: JM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019-02-16).
• Keywords: COVID-19, intensive care, social deprivation, mortality.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Puxty, Dr Kathryn and McPeake, Dr Jo
• Authors: Lone, N. I., McPeake, J., Stewart, N. I., Blayney, M. C., Chan Seem, R., Donaldson, L., Glass, E., Haddow, C., Hall, R., Martin, C., Paton, M., Smith-Palmer, A., Kaye, C. T., and Puxty, K.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Lancet Regional Health - Europe
• Publisher: Lancet Publishing Group
• ISSN: 2666-7762
• ISSN (Online): 2666-7762
• Published Online: 15 December 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in Lancet Regional Health - Europe 1: 100005
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
307748		Improving health and social care integration delivery in the acute care environment	Joanne McPeake	University of Cambridge (HEI-CAMB)	RG88620	HW - MRC/CSO Social and Public Health Sciences Unit