Intermediate or Intensive Care Unit Admission across Race and Ethnicity

No studies have assessed the association of race and ethnicity with intermediate care unit (IMCU) or intensive care unit (ICU) admission among hospitalized patients after controlling for comorbidities. These studies, however, can motivate studies on accumulated structural inequalities in access to opportunity and health resources across the life course to inequitable healthcare access and implicit bias. As such, the aim of this study was to describe the demographic characteristics and comorbidities of patients admitted to IMCUs or ICUs, and to assess the association of race and ethnicity on the use of IMCU or ICU services among hospitalized patients. Abstract Objectives The aim of this study was to assess the association between race and ethnicity and admission to intermediate (IMCUs) or intensive care units (ICUs) among hospitalized patients. Methods Using Florida hospital discharge data from the Agency for Healthcare Research and Quality–sponsored State Inpatient Database in 2017, we assessed the relationship between race (White, Black, Other) and Hispanic ethnicity and IMCU or ICU admission. Demographic covariates included age, sex, quartile of household income for patient ZIP code, insurance status, and patient residence. An adjusted model assessed the association between race and ethnicity and IMCU or ICU admission using log binomial regression with generalized estimating equations after controlling for demographic characteristics and the Elixhauser Comorbidity Index. Results After controlling for demographics and comorbidities, the prevalence of IMCU or ICU admission was higher among non-Hispanic Blacks (adjusted prevalence ratio [aPR] 1.04; 95% confidence interval [CI] 1.02–1.05) and non-Hispanic patients of other races (aPR 1.03; 95% CI 1.01–1.04) compared with non-Hispanic Whites. The prevalence of IMCU or ICU use was lower among Hispanic Whites (aPR 0.98; 95% CI 0.86–1.00) and Hispanics of other races (aPR 0.96; 95% CI 0.95–0.98) compared with non-Hispanic Whites after controlling for other demographic characteristics and comorbidities. Conclusions Among hospitalized patients, racial minorities are slightly more likely to use higher levels of care, whereas Hispanic patients are generally slightly less likely than non-Hispanic White patients to use higher levels of care. Further evaluation is needed to identify reasons for disparate IMCU or ICU admission.