A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems
Wernly, Bernhard (General Hospital Oberndorf)
Flaatten, Hans (Haukeland University Hospital (Bergen, Noruega))
Beil, Michael (Hebrew University of Jerusalem)
Fjølner, Jesper (Viborg Regional Hospital)
Bruno, Raphael Romano (Heinrich-Heine-University Duesseldorf)
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Pinto, Bernardo Bollen (Geneva University Hospitals)
Schefold, Joerg C. (University of Bern)
Kelm, Malte (Heinrich-Heine-University Duesseldorf)
Sigal, Sviri (Hebrew University of Jerusalem)
van Heerden, Peter Vernon (Hebrew University of Jerusalem)
Szczeklik, Wojciech (Jagiellonian University Medical College)
Elhadi, Muhammed (University of Tripoli)
Joannidis, Michael (Medical University Innsbruck)
Rezar, Richard (Paracelsus Medical University of Salzburg)
Oeyen, Sandra (Universitair Ziekenhuis Gent)
Wolff, Georg (Heinrich-Heine-University Duesseldorf)
Marsh, Brian (Mater Misericordiae University Hospital(Dublín, Irlanda))
Andersen, Finn H. (Norwegian University of Science and Technology)
Moreno, Rui (Universidade da Beira Interior)
Wernly, Sarah (General Hospital Oberndorf)
Leaver, Susannah (St. George's University Hospital NHS Foundation Trust)
Boumendil, Ariane (Hôpital Saint-Antoine (França))
De Lange, Dylan W. (University Utrecht)
Guidet, Bertrand (Hôpital Saint-Antoine (França))
Perings, Stefan (Heinrich-Heine-University Duesseldorf)
Jung, Christian (Heinrich-Heine-University Duesseldorf)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0. 002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0. 09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0. 001) were found in SHI (aOR 0. 61 95%CI 0. 40-0. 92; p = 0. 02). No differences regarding intubation rates (68% vs. 70%; p = 0. 33), vasopressor use (67% vs. 67%; p = 0. 90) and 30-day-mortality rates (47% vs. 50%; p = 0. 16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Epidemiology ; Outcomes research
Published in:	Scientific reports, Vol. 12 (october 2022) , ISSN 2045-2322

DOI: 10.1038/s41598-022-21580-y
PMID: 36261587

9 p, 1.2 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles