Socioeconomic status, severity of disease and level of family members' care in adult surgical intensive care patients: the prospective ECSSTASI study

Thomas Bein, Kathrin Hackner, Tianya Zou, Sybille Schultes, Teresa Bösch, Hans Jürgen Schlitt, Bernhard M Graf, Matthias Olden, Michael Leitzmann, Thomas Bein, Kathrin Hackner, Tianya Zou, Sybille Schultes, Teresa Bösch, Hans Jürgen Schlitt, Bernhard M Graf, Matthias Olden, Michael Leitzmann

Abstract

Background: Low socioeconomic status (SES) is associated with increased mortality from cardiovascular disease, cancer and trauma. However, individual-level prospective data on SES in relation to health outcomes among critically ill patients admitted to intensive care units (ICU) are unavailable.

Methods: In a cohort of 1,006 patients at a 24-bed surgical ICU of an academic tertiary care facility in Germany, we examined levels of SES in relation to disease severity at admission, time period of mechanical ventilation, length of stay and frequency of phone calls and visits by next-of-kin.

Findings: Patients with low SES had higher risk for Sequential Organ Failure Assessment (SOFA) score greater or equal to 5 [multivariate-adjusted odds ratio (OR) 1.49; 95% confidence interval (CI) 0.95-2.33; p = 0.029] and a trend for higher risk for Simplified Acute Physiology Score (SAPS II) greater or equal to 31 (OR 1.28; 95% CI 0.80-2.05; p = 0.086) at admission as compared with patients with high SES. When compared with men with high SES, those with low SES had greater risk for ICU treatment ≥ 5 days (multivariate-adjusted OR 1.99; 95% CI 1.06-3.74; p = 0.036) and showed a trend for a low number of visits from next-of-kin (<0.5 visits per day) (OR 1.85; 95% CI 0.79-4.30; p = 0.054). In women such associations could not be demonstrated.

Interpretation: Socioeconomic status is inversely related to severity of disease at admission and to length of stay in ICU, and positively associated with the level of care by next-of-kin. Whether relations differ by gender requires further examination.

Figures

Fig. 1
Fig. 1
Proportions of patients with high, intermediate and low SES in comparison with the general population in Germany, 2009 [18]

References

    1. Adler NE, Ostrove JM. Socioeconomic status and health: what we know and what we don’t. Ann N Y Acad Sci. 1999;896:3–15. doi: 10.1111/j.1749-6632.1999.tb08101.x.
    1. Schwartz KL, Crossley-May H, Vigneau FD, Brown K, Banerjee M. Socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control. 2003;14:761–766. doi: 10.1023/A:1026321923883.
    1. Pruitt SL, Shim MJ, Mullen PD, Vernon SW, Amick BC., 3rd Association of area socioeconomic status and breast, cervical, and colorectal cancer screening: a systematic review. Cancer Epidemiol Biomarkers Prev. 2009;18:2579–2599. doi: 10.1158/1055-9965.EPI-09-0135.
    1. Lantz PM, Golberstein E, House JS, Morenoff J. Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults. Soc Sci Med. 2010;70:1558–1566. doi: 10.1016/j.socscimed.2010.02.003.
    1. Haider AH, Chang D, Efron DT, Haut ER, Crandall M, Cornell EE., 3rd Race and insurance status as risk factors for trauma mortality. Arch Surg. 2008;143:945–949. doi: 10.1001/archsurg.143.10.945.
    1. Cox AM, McKevitt C, Rudd AG, Wolfe CD. Socioeconomic status and stroke. Lancet Neurol. 2006;5:181–188. doi: 10.1016/S1474-4422(06)70351-9.
    1. Goldbourt U, Schnaider-Beeri M, Davidson M. Socioeconomic status in relation to death of vascular disease and late-life dementia. J Neurol Sci. 2007;257:177–181. doi: 10.1016/j.jns.2007.01.021.
    1. Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. “Fundamental causes” of social inequalities in mortality: a test of theory. J Health Soc Behav. 2004;45:265–285. doi: 10.1177/002214650404500303.
    1. Ho KM, Dobb GJ, Knuiman M, Knuiman M, Finn J, Webb SA. The effect of socioeconomic status on outcomes for seriously ill patients: a linked data cohort study. Med J Aust. 2008;189:26–30.
    1. Welch CA, Harrison DA, Hutchings A, Rowan K. The association between deprivation and hospital mortality for admissions to critical care units in England. J Crit Care. 2010;25:382–390. doi: 10.1016/j.jcrc.2009.11.003.
    1. Lampert T, Kroll LE. Income differences in health and life expectancy—cross-sectional and longitudinal findings of the German Socio-Economic Panel (GSOEP)] Gesundheitswesen. 2006;68:219–230. doi: 10.1055/s-2006-926638.
    1. Winkler J, Stolzenberg H. Social class index in the Federal Health Survey. Gesundheitswesen. 1999;61:S178–S183.
    1. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–2963. doi: 10.1001/jama.1993.03510240069035.
    1. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:1754–1758. doi: 10.1001/jama.286.14.1754.
    1. Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review. Crit Care. 2008;12:R161. doi: 10.1186/cc7160.
    1. Tyrie LS, Mosenthal AC. Care of the family in the surgical intensive care unit. Surg Clin N Am. 2011;91:333–342. doi: 10.1016/j.suc.2011.01.003.
    1. Fueglistaler P, Amsler F, Schüepp M, Fueglistaler-Montali I, Attenberger C, Pargger H, Jacob AL, Gross T. Prognostic value of Sequential Organ Failure Assessment and Simplified Acute Physiology II score compared with trauma scores in the outcome of multiple-trauma patients. Am J Surg. 2010;200:204–214. doi: 10.1016/j.amjsurg.2009.08.035.
    1. Socioeconomic panel (SOEP), Infratest Sozialforschung 2009; (in german, last visit 10.10.2011)
    1. Lampert T. Smoking, physical inactivity, and obesity: associations with social status. Dtsch Arztebl Int. 2010;107:1–7.
    1. Faggiano F, Partanen T, Kogevinas M, Boffetta P. Socioeconomic differences in cancer incidence and mortality. IARC Sci Publ. 1997;138:65–176.
    1. Fried LP, Kronmal RA, Newman AB, Bild DE, Mittelmark MB, Polak JF, Robbnis JA, Gardin JM. Risk factors for 5-year mortality in older adults: the cardiovascular health study. JAMA. 1998;279:585–592. doi: 10.1001/jama.279.8.585.
    1. Hutchings A, Raine R, Brady A, Wildman M, Rowan K. Socioeconomic status and outcome from intensive care in England and Wales. Med Care. 2004;42:943–951. doi: 10.1097/00005650-200410000-00002.
    1. Erickson SE, Vasilevskis EE, Kuzniewicz MW, Cason BA, Lane RK, Dean ML, Rennie DJ, Dudley RA. The effect of race and ethnicity on outcomes among patients in the intensive care unit: a comprehensive study involving socioeconomic status and resuscitation preferences. Crit Care Med. 2011;39:429–435. doi: 10.1097/CCM.0b013e318206b3af.
    1. Case A, Paxson C. Sex differences in morbidity and mortality. Demography. 2005;42:189–214. doi: 10.1353/dem.2005.0011.
    1. Oksuzyan A, Juel K, Vaupel JW, Christensen K. Men: good health and high mortality. Sex differences in health and aging. Aging Clin Exp Res. 2008;20:91–102.
    1. Eriksson T, Bergbom I. Visits to intensive care patients—frequency, duration and impact on outcome. Nurs Crit Care. 2007;12:20–26. doi: 10.1111/j.1478-5153.2006.00196.x.
    1. Firth P. Patients and their families. Recent Results Cancer Res. 2006;168:61–71. doi: 10.1007/3-540-30758-3_6.
    1. Thalanany MM, Mugford M, Mitchell-Inwang C. Visiting adult patients in intensive care: the importance of relatives’ travel and time costs. Intensive Crit Care Nurs. 2006;22:40–48. doi: 10.1016/j.iccn.2005.10.004.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다