Racial and Geographic Disparities in Interhospital ICU Transfers

Abstract

Objective—Inter-hospital transfer (IHT), a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease-related would be found between patients who were and were not transferred. Design—Retrospective cohort study. Setting—Nationwide Inpatient Sample, 2006–2012. Patients—Patients over 18 years of age with a primary diagnosis of sepsis who underwent mechanical ventilation. Interventions—none Measurements and Main Results—We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser co-morbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (OR 0.98, 95% CI 0.978–0.982), black race (OR 0.79, 95% CI 0.70–0.89), Hispanic race (OR 0.79, 95% CI 0.69– 0.90), South region hospital (OR 0.79, 0.72–0.88), teaching hospital (OR 0.31, 95% CI 0.28– 0.33), and DNR status (OR 0.19, 95% CI 0.15–0.25). Conclusions—In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.