Critical care outcomes in ICUs have improved steadily over the past decade, but only for hospitals with few minority patients, according to a recent analysis.
“The motivation for this study was to determine the impact of being treated in a minority hospital would have on outcomes in sepsis,” says Barret Rush, MD, MPH, the study’s lead author and an assistant professor of medicine at the University of Manitoba.
Rush and colleagues analyzed ICU length of stay and mortality data from more than 200 U.S. hospitals collected between 2006 and 2016. They compared the data at minority-serving hospitals (defined as seeing more than 25% African American and/or Hispanic patients in its ICU) or non-minority hospitals. Racial disparities have been demonstrated across all aspects of healthcare. “However, the analysis here determined that the minority-serving hospital itself is a risk factor for worse outcomes, regardless of the individual patient’s race,” Rush reports.
ICU deaths declined 2% steadily annually at non-minority hospitals. This was not true of minority-serving hospitals. Those hospitals also reported longer lengths of stay and more critical illness than non-minority hospitals.
Since the treatment for sepsis is well-established, the researchers were unsure if there would be worse outcomes in patients treated in hospitals that were disproportionately minority-serving. “In fact, we demonstrated, after adjustment for severity of illness, comorbidities, race, socioeconomic status, and more, that all patients, regardless of race, treated at minority-serving hospitals had significantly worse outcomes,” Rush says.
There were particularly stark differences in care for critically ill African Americans. If treated at non-minority hospitals, this group exhibited a 3% decline in mortality each year compared to no change in mortality for minority-serving hospitals. “The ethical implications are quite vast,” Rush observes.
The next step is to explore whether further funding should be directed to disproportionately minority hospitals to improve care delivery, according to Rush. “Attempting to understand the reasons for this significantly disparate outcomes is crucial to improving the healthcare delivery to these minority patients,” he says.