Socioeconomic factors and non-admission to the intensive care unit decisions in hospitalised COVID-19 patients: a retrospective cohort study in Stockholm, Sweden

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OBJECTIVE: To investigate the association between socioeconomic factors (education level, region of birth and household composition) and non-admission to the intensive care unit (ICU) decisions in patients hospitalised with COVID-19. DESIGN: Retrospective multicentre cohort study using linkage of several population-based health registries. SETTING: Five acute care hospitals in Region Stockholm, Sweden, between March 2020 and February 2023. PARTICIPANTS: Data were extracted from 20 764 patients aged ≥18 years hospitalised with COVID-19. MAIN OUTCOME MEASURE: A recorded decision of non-admission to the ICU within 72 hours of admission. We used a modified Poisson regression model for each socioeconomic factor separately, adjusting for the other socioeconomic factors, age, sex, comorbidities, care services, calendar time, hospital and ICU occupancy. RESULTS: Among 20 764 individuals, 2823 (13.6%) received a non-admission to the ICU decision. In the adjusted model, completion of primary or secondary education as the highest level was associated with an increased risk of receiving a decision of non-admission to the ICU (adjusted risk ratio (aRR) 1.20 (95% CI 1.10 to 1.30, p<0.01) and aRR 1.14 (95% CI 1.05 to 1.23, p<0.01), respectively) compared with completion of tertiary education. Being born in Northwestern Europe and Northern America, as opposed to Sweden specifically, was also associated with an increased risk (aRR 1.15 (95% CI 1.06 to 1.26, p<0.01)). CONCLUSION: We observed an increased risk of receiving a non-admission to the ICU decision for patients with lower levels of education and those born in Northwestern Europe or Northern America. This calls for action by physicians and policymakers to address socioeconomic inequities in access to intensive care.

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