ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
Search Tips:
- Use the keyword search to search by keyword or author's name.
- Filter your search results by selecting the checkboxes that apply.
- Click on "Clear" to clear the form and start a new search. .
Search results will display below the form.
The Effect of Socioeconomic Disadvantage on Development of Functional Decline Following Critical Illness Among Older Adults
Session Title
D9 - D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS
Abstract
A1214 - The Effect of Socioeconomic Disadvantage on Development of Functional Decline Following Critical Illness Among Older Adults
Author Block: S. Jain1, T. E. Murphy2, J. R. O'Leary2, L. Leo-Summers2, L. E. Ferrante3; 1Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, United States, 2Section of Geriatrics, Yale University School of Medicine, New Haven, CT, United States, 3Internal Medicine, Yale School of Medicine, New Haven, CT, United States.
Rationale: Socioeconomic disadvantage is associated with greater long-term mortality in older adults who survive critical illness. Whether socioeconomically disadvantaged older adults are at greater risk of development of functional decline compared to their less vulnerable counterparts is not known. We sought to examine the association between socioeconomic disadvantage and functional decline in a nationally representative sample of Medicare beneficiaries. Methods: We identified community-dwelling older adults in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries ages ≥65, who underwent annual assessments of disability in 7 functional activities. ICU hospitalizations were identified using critical care revenue codes in linked Medicare claims. ICU survivors were eligible for the analysis and the unit of analysis was participant-ICU stays. We used a negative binomial Poisson model to evaluate the association between dual-eligibility and the count of disabilities (range 0-7) assessed in the NHATS interview following discharge from the ICU hospitalization. Covariates in the model included age, gender, education, living alone, frailty, hospital length of stay, mechanical ventilation, and count of disabilities in the interview preceding ICU admission. Results: We identified 641 participant-ICU stays representing 3,767,695 ICU hospitalizations after survey-weighting. Dual eligible beneficiaries were more frequently males, of minority race, had less than high school level education, and lived alone, compared with those without Medicaid (Table 1). The median post-ICU disability count was 2.18 (IQR 0.00, 4.83) for dual-eligible participants and 0.01 (IQR 0.00, 2.47) for participants without Medicaid. Unadjusted, Medicaid eligibility was strongly associated with post-ICU disability with a 60% increase in post-ICU disability count compared to those who did not have Medicaid (unadjusted RR 1.60, 95% CI 1.29, 1.99). After covariate adjustment, Medicaid status was still positively associated with post-ICU disability with a 32% increase in post-ICU disability count relative to non-Medicaid beneficiaries (adjusted RR 1.32, 95% CI 1.04, 1.67). Conclusions: In this nationally representative sample of Medicare beneficiaries who survived ICU hospitalization, socioeconomic disadvantage was associated with greater risk of post-ICU disability after accounting for pre-ICU disability, frailty, and other relevant sociodemographic and clinical characteristics. This warrants investigation into factors underlying this disparity as well as consideration for post-ICU rehabilitation and recovery programs.
Author Block: S. Jain1, T. E. Murphy2, J. R. O'Leary2, L. Leo-Summers2, L. E. Ferrante3; 1Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, United States, 2Section of Geriatrics, Yale University School of Medicine, New Haven, CT, United States, 3Internal Medicine, Yale School of Medicine, New Haven, CT, United States.
Rationale: Socioeconomic disadvantage is associated with greater long-term mortality in older adults who survive critical illness. Whether socioeconomically disadvantaged older adults are at greater risk of development of functional decline compared to their less vulnerable counterparts is not known. We sought to examine the association between socioeconomic disadvantage and functional decline in a nationally representative sample of Medicare beneficiaries. Methods: We identified community-dwelling older adults in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries ages ≥65, who underwent annual assessments of disability in 7 functional activities. ICU hospitalizations were identified using critical care revenue codes in linked Medicare claims. ICU survivors were eligible for the analysis and the unit of analysis was participant-ICU stays. We used a negative binomial Poisson model to evaluate the association between dual-eligibility and the count of disabilities (range 0-7) assessed in the NHATS interview following discharge from the ICU hospitalization. Covariates in the model included age, gender, education, living alone, frailty, hospital length of stay, mechanical ventilation, and count of disabilities in the interview preceding ICU admission. Results: We identified 641 participant-ICU stays representing 3,767,695 ICU hospitalizations after survey-weighting. Dual eligible beneficiaries were more frequently males, of minority race, had less than high school level education, and lived alone, compared with those without Medicaid (Table 1). The median post-ICU disability count was 2.18 (IQR 0.00, 4.83) for dual-eligible participants and 0.01 (IQR 0.00, 2.47) for participants without Medicaid. Unadjusted, Medicaid eligibility was strongly associated with post-ICU disability with a 60% increase in post-ICU disability count compared to those who did not have Medicaid (unadjusted RR 1.60, 95% CI 1.29, 1.99). After covariate adjustment, Medicaid status was still positively associated with post-ICU disability with a 32% increase in post-ICU disability count relative to non-Medicaid beneficiaries (adjusted RR 1.32, 95% CI 1.04, 1.67). Conclusions: In this nationally representative sample of Medicare beneficiaries who survived ICU hospitalization, socioeconomic disadvantage was associated with greater risk of post-ICU disability after accounting for pre-ICU disability, frailty, and other relevant sociodemographic and clinical characteristics. This warrants investigation into factors underlying this disparity as well as consideration for post-ICU rehabilitation and recovery programs.
