Racial disparities have previously been identified across a range of health care environments, sometimes extending into the highest levels of care. A new study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) reveals that while critical care outcomes in intensive care units (ICUs) steadily improved over a decade at hospitals with few minority patients, ICUs with a more diverse patient population did not progress comparably. Published today in the American Journal of Respiratory and Critical Care Medicine, the findings reveal that the gap is most apparent for critically ill African-American patients.
Lead author John Danziger, MD, MPhil, a nephrologist at BIDMC, and colleagues examined trends in ICU mortality and length of stay from 2006 to 2016 in more than 200 hospitals across the United States. To examine differences in critical care outcomes across hospitals, the team compared the data between two types of institutions. For the purpose of the study, hospitals with a greater than 25 percent African-American and/or Hispanic ICU patient census were defined as minority-serving hospitals, while those with less were identified as non-minority hospitals.
The team found a steady annual decline of two percent in ICU deaths at non-minority hospitals; however, the same improvement in mortality rate was not seen at minority-serving hospitals. Minority-serving hospitals also reported longer lengths of ICU stay and critical illness hospitalizations than non-minority hospitals.
In addition to the disparity for all ICU patients seen in minority-serving hospitals, the researchers observed a particularly stark difference in care for critically ill African-American patients. African-Americans treated at non-minority hospitals experienced a three percent decline in mortality each year, compared to no decline in mortality when treated at minority-serving hospitals.
While the study does not determine whether the outcomes at minority-serving hospitals are due to differences in hospital resources and practices or a systemic disparity of these patient populations, the findings highlight the profound obstacles minorities and minority-serving hospitals face.
Although our analysis does not resolve the reasons for differences in outcomes, it identifies minority serving hospitals as an area of great need. Focusing research efforts to further address these inequalities is critical in mitigating the disadvantages minorities face and ultimately closing the health care divide.
John Danziger, a nephrologist at BIDMC
Danziger, J. et al. (2020) Temporal Trends in Critical Care Outcomes in United States Minority Serving Hospitals. American Journal of Respiratory and Critical Care Medicine. doi.org/10.1164/rccm.201903-0623OC