Influence of Socioeconomic Deprivation on Interventions and Outcomes for Patients Admitted with COVID-19 to Critical Care Units in Scotland: A National Cohort Study

Abstract

Background: Coronavirus disease 2019 (COVID-19) can lead to significant respiratory failure with between 14% and 18% of hospitalised patients requiring critical care admission. This study describes the impact of socioeconomic deprivation on 30-day survival following critical care admission for COVID-19, and the impact of the COVID-19 pandemic on critical care capacity in Scotland.Methods: This cohort study used linked national hospital records including ICU, virology testing and national death records to identify and describe patients with COVID-19 admitted to a critical care unit in Scotland. Multivariable logistic regression was used to assess the impact of deprivation on 30-day mortality. Critical care capacity was described by reporting the percentage of baseline ICU bed utilisation required.Results: There were 735 patients with COVID-19 admitted to critical care units across Scotland from 1/3/2020 to 20/6/2020. There was a higher proportion of patients from more deprived areas, with 183 admissions (24.9%) from the most deprived quintile and 100 (13.6%) from the least deprived quintile. 30-day mortality was 34.8%. After adjusting for age, sex and ethnicity, mortality was significantly higher in patients from the most deprived quintile (OR 1.97, 95%CI 1.13, 3.41, p=0.016). ICUs serving populations with higher levels of deprivation spent a greater amount of time over their baseline ICU bed capacity.Conclusion: Patients with COVID-19 living in areas with greater socioeconomic deprivation had a higher frequency of critical care admission and a higher adjusted 30-day mortality. ICUs in health boards with higher levels of socioeconomic deprivation had both higher peak occupancy and longer duration of occupancy over normal maximum capacity.Funding Statement: None.Declaration of Interests: All authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; NL is Director of Research, Intensive Care Society; JM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019-02-16). Ethics Approval Statement: The Scottish Intensive Care Society Audit Group in Public Health Scotland has a legislative remit to process personal data in relation to public health. Linkage to additional datasets was approved following scrutiny by the Public Benefit and Privacy Panel for Health and Social Care (ref 1920-0093). Access and use of the data for the purpose of this work were approved following a Public Health Scotland information governance review of linking additional internal datasets to identify patients with COVID-19. Only analysts working in Public Health Scotland had access to the linked patient data which could only be accessed via an NHS secure network.