OBJECTIVES: 

Factors common to socioeconomically disadvantaged neighborhoods, such as low availability of transportation, may limit access to restorative care services for critical illness survivors. Our primary objective was to evaluate whether neighborhood socioeconomic disadvantage was associated with an increased disability burden after critical illness. Our secondary objective was to determine if the effect differed for those discharged to the community compared with those discharged to a facility.

DESIGN: 

Longitudinal cohort study with linked Medicare claims data.

SETTING: 

United States.

PATIENTS: 

One hundred ninety-nine older adults, contributing to 239 ICU admissions, who underwent monthly assessments of disability for 12 months following hospital discharge in 13 different functional tasks from 1998 to 2017.

MEASUREMENTS AND MAIN RESULTS: 

Neighborhood disadvantage was assessed using the area deprivation index, a 1–100 ranking evaluating poverty, housing, and employment metrics. Those living in disadvantaged neighborhoods (top quartile of scores) were less likely to self-identify as non-Hispanic White compared with those in more advantaged neighborhoods. In adjusted models, older adults living in disadvantaged neighborhoods had a 9% higher disability burden over the 12 months following ICU discharge compared with those in more advantaged areas (rate ratio, 1.09; 95% Bayesian credible interval, 1.02–1.16). In the secondary analysis adjusting for discharge destination, neighborhood disadvantage was associated with a 14% increase in disability burden over 12 months of follow-up (rate ratio, 1.14; 95% credible interval, 1.07–1.21). Disability burden was 10% higher for those living in disadvantaged neighborhoods and discharged home as compared with those discharged to a facility, but this difference was not statistically significant (interaction rate ratio, 1.10; 95% credible interval, 0.98–1.25).

CONCLUSIONS: 

Neighborhood socioeconomic disadvantage is associated with a higher disability burden in the 12 months after a critical illness. Future studies should evaluate barriers to functional recovery for ICU survivors living in disadvantaged neighborhoods.

中文翻译：

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危重疾病后的社区社会经济劣势和残疾*

 目标：

社会经济弱势社区的常见因素，例如交通便利性低，可能会限制危重疾病幸存者获得恢复性护理服务。我们的主要目标是评估社区社会经济劣势是否与危重病后残疾负担增加相关。我们的次要目标是确定出院到社区的人员与出院到设施的人员相比，效果是否有所不同。

 设计：

具有相关医疗保险索赔数据的纵向队列研究。

 环境：

 美国。

 患者：

从 1998 年到 2017 年，共有 199 名老年人入院 239 例，他们在出院后的 12 个月内每月接受 13 项不同功能任务的残疾评估。

测量和主要结果：

使用面积剥夺指数来评估邻里劣势，该指数是评估贫困、住房和就业指标的 1-100 排名。与生活在条件较好的社区的人相比，生活在贫困社区的人（得分最高的四分之一）不太可能自我认同为非西班牙裔白人。在调整后的模型中，与生活在条件较好地区的老年人相比，生活在贫困社区的老年人在 ICU 出院后 12 个月内的残疾负担高出 9%（比率，1.09；95% 贝叶斯可信区间，1.02-1.16）。在调整出院目的地的二次分析中，在 12 个月的随访期间，邻里劣势与残疾负担增加 14% 相关（比率，1.14；95% 可信区间，1.07-1.21）。与出院到机构的人相比，生活在贫困社区并出院回家的人的残疾负担高出 10%，但这种差异并不具有统计显着性（交互率比，1.10；95% 可信区间，0.98-1.25）。

 结论：

社区社会经济劣势与危重疾病后 12 个月内较高的残疾负担相关。未来的研究应该评估生活在贫困社区的 ICU 幸存者功能恢复的障碍。