Racial & ethnic disparities in geographic access to critical care in the United States: A geographic information systems analysis.

Autor: Burdick KJ; Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States of America., Rees CA; Division of Emergency Medicine, Emory University, Atlanta, GA, United States of America., Lee LK; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America.; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States of America., Monuteaux MC; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America.; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States of America., Mannix R; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America.; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States of America., Mills D; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America.; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States of America., Hirsh MP; Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States of America., Fleegler EW; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States of America.; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Nov 01; Vol. 18 (11), pp. e0287720. Date of Electronic Publication: 2023 Nov 01 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0287720
Abstrakt: Objective: It is important to identify gaps in access and reduce health outcome disparities, understanding access to intensive care unit (ICU) beds, especially by race and ethnicity, is crucial. Our objective was to evaluate the race and ethnicity-specific 60-minute drive time accessibility of ICU beds in the United States (US).
Design: We conducted a cross-sectional study using road network analysis to determine the number of ICU beds within a 60-minute drive time, and calculated adult intensive care bed ratios per 100,000 adults. We evaluated the US population at the Census block group level and stratified our analysis by race and ethnicity and by urbanicity. We classified block groups into four access levels: no access (0 adult intensive care beds/100,000 adults), below average access (>0-19.5), average access (19.6-32.0), and above average access (>32.0). We calculated the proportion of adults in each racial and ethnic group within the four access levels.
Setting: All 50 US states and the District of Columbia.
Participants: Adults ≥15 years old.
Main Outcome Measures: Adult intensive care beds/100,000 adults and percentage of adults national and state) within four access levels by race and ethnicity.
Results: High variability existed in access to ICU beds by state, and substantial disparities by race and ethnicity. 1.8% (n = 5,038,797) of Americans had no access to an ICU bed, and 26.8% (n = 73,095,752) had below average access, within a 60-minute drive time. Racial and ethnic analysis showed high rates of disparities (no access/below average access): American Indians/Alaskan Native 12.6%/28.5%, Asian 0.7%/23.1%, Black or African American 0.6%/16.5%, Hispanic or Latino 1.4%/23.0%, Native Hawaiian and other Pacific Islander 5.2%/35.0%, and White 2.1%/29.0%. A higher percentage of rural block groups had no (5.2%) or below average access (41.2%), compared to urban block groups (0.2% no access, 26.8% below average access).
Conclusion: ICU bed availability varied substantially by geography, race and ethnicity, and by urbanicity, creating significant disparities in critical care access. The variability in ICU bed access may indicate inequalities in healthcare access overall by limiting resources for the management of critically ill patients.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Burdick et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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