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Healthcare Disparities in Critical Illness

Soto, Graciela J. MD, MS1; Martin, Greg S. MD, MSc2; Gong, Michelle Ng MD, MS1,3

doi: 10.1097/CCM.0b013e3182a84a43
Concise Definitive Review

Objective: To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness.

Data Sources: MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest.

Study Selection: Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities.

Data Extraction: Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness.

Data Synthesis: This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness.

Conclusions: The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.

1Division of Critical Care Medicine, Department of Medicine, Jay B. Langner Critical Care Service, Montefiore Medical Center, Bronx, NY.

2Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Emory University, Grady Memorial Hospital, Atlanta, GA.

3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Martin is supported by grants from the National Center for Advancing Translational Sciences (UL1 TR000454), National Heart, Lung and Blood Institute (R21 HL110044), National Institute of Alcohol Abuse and Alcoholism (P50 AA013757), and Food and Drug Administration (FDA) (R01 FD003440). Dr. Martin served as a board member for Cumberland Pharmaceuticals, Astra Zeneca, Pulsion Medical Systems, and Agennix; consulted for Astra Zeneca; and received support for article research from the National Institutes of Health (NIH). His institution received grant support from NIH and FDA. Dr. Gong is supported by the following grants from the NHLBI: R01 HL086667, UO1 HL108712, and R01 AG035117. She is employed by Montefiore Medical Center; lectured for Beth Israel Deaconess Medical Center, Columbia University, Mt Sinai Hospital (Grand Rounds lectures); and received support for article research from NIH. His institution received grant support from NIH. Dr. Soto has disclosed that she does not have any potential conflicts of interest.

Address requests for reprints to: Graciela J. Soto, MD, MS, Division of Critical Care Medicine, Department of Medicine, Jay B. Langner Critical Care Service, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467. E-mail: gsoto@montefiore.org

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins