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2024 | 7 | 2 | 12-19

Article title

Racial disparities in utilization of ECMO in COVID-19 patients: a retrospective population-based analysis

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Abstracts

EN
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a crucial intervention for severe respiratory failure, including in cases of COVID-19. Medical research has shown disparities in multiple fields of healthcare as well as in the utilisation of ECMO. Racial disparities in the utilisation of ECMO among COVID-19 patients are a concern, which requires investigation to ensure equitable access to life-saving treatments. To our knowledge, no study that have specifically evaluated the utilisation of ECMO among COVID-19 patients. Our aim from this study is to explore racial disparities in healthcare care, and specifically in the use of ECMO. The objective of the study was to evaluate any possible disparities that exist in the odds of receiving ECMO based on race after correcting for other confounding factors in patients admitted with COVID-19 pneumonia. MATERIALS AND METHODS: This retrospective study analysed data from the National Inpatient Sample (NIS) database spanning 2019 to 2020. A total of 1,507,585 admissions for COVID-19 pneumonia were examined, of which 3,070 required ECMO. Statistical analyses, including adjusted odds ratios and multivariate logistic regression models, were employed to assess the association between race and ECMO utilisation using STATA 17 version RESULTS: The mean age of the studied population was 48.85 with a standard deviation of 0.5. 1075 white patients have utilized the ECMO when admitted to the hospital, compared to 605 black patients, 1055 Hispanics, 90 Asians, 75 Native Americans and 170 patients in ‘Others’ race group. Adjusted odds ratios for receiving ECMO, compared to Whites as the reference group, did not reveal statistically significant differences for African Americans (OR 1.03; 95% CI 0.75 - 1.40; P value = 0.86) and Asians (OR 1.04; 95% CI 0.75 - 1.75; P value = 0.86). Hispanics showed a significantly higher probability of receiving ECMO (OR 1.32; 95% CI 1.01 - 1.73; P-value=0.04), as did Native Americans (OR 2.16; 95% CI 1.18 - 3.94; P-value=0.012). CONCLUSIONS: Addressing disparities in ECMO utilisation is crucial to ensure equitable access to lifesaving interventions among COVID-19 patients. Strategies to mitigate racial disparities in healthcare access and treatment are essential to optimise patient outcomes and fostering health equity.

Year

Volume

7

Issue

2

Pages

12-19

Physical description

Dates

published
2024

Contributors

  • Department of Internal medicine, East Tennessee State University, Johnson City, TN, USA
  • Department of Internal medicine, East Tennessee State University, Johnson City, TN, USA
  • Department of Internal medicine, East Tennessee State University, Johnson City, TN, USA
  • Department of Cardiovascular disease, East Tennessee State University, Johnson City, TN, USA
  • Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA

References

  • Bertini P, Guarracino F, Falcone M, Nardelli P, Landoni G, Nocci M, et al. ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth. 2022; 36 (8 Pt A): 2700-2706. doi: https://doi.org/10.1053/j.jvca.2021.11.006
  • Combes A, Peek GJ, Hajage D, Hardy P, Abrams D, Schmidt M, et al. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive Care Med. 2020; 46(11): 2048-2057. doi: https://doi.org/10.1007/s00134-020-06248-3
  • Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med. 2020; 8(11): 1121-1131. doi: https://doi.org/10.1016/S2213-2600(20)30328-3
  • Badulak J, Antonini MV, Stead CM, Shekerdemian L, Raman L, Paden ML, et. al. Extracorporeal Membrane oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization. ASAIO J. 2021; 67(5): 485-495. doi: https://doi.org/10.1097/MAT.0000000000001422
  • Boehmer TK, Koumans EH, Skillen EL, Kappelman MD, Carton TW, Patel A, et al. Racial and Ethnic Disparities in Outpatient Treatment of COVID-19 ― United States, January–July 2022. MMWR Morb Mortal Wkly Rep. 2022; 71(43): 1359–1365 doi: https://doi.org/10.15585/mmwr.mm7143a2
  • Mehta AB, Taylor JK, Day G, Lane TC, Douglas IS. Disparities in Adult Patient Selection for Extracorporeal Membrane Oxygenation in the United States: A Population-Level Study. Ann Am Thorac Soc. 2023; 20(8): 1166-1174. doi: https://doi.org/10.1513/AnnalsATS.202212-1029OC
  • Magesh S, John D, Li WT, Li Y, Mattingly-App A, Jain S, et al. Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status: A Systematic Review and Meta-analysis. JAMA Netw Open. 2021; 4(11): e2134147. doi: https://doi.org/10.1001/jamanetworkopen.2021.34147
  • Richardson S, Verma A, Sanaiha Y, Chervu NL, Pan C, Williamson CG, et al. Racial disparities in outcomes for extracorporeal membrane oxygenation in the United States. Am J Surg. 2023; 225(1): 113-117. doi: https://doi.org/10.1016/j.amjsurg.2022.09.034
  • Kopanczyk R, Steven L, Pearl R, Demiralp G, Naik BI, Mazzeffin MA. Racial and Ethnic Disparities in VenoVenous Extracorporeal Membrane Oxygenation Mortality for Patients with Severe COVID-19. ASAIO J. 2024; 70(1): 62-67. doi: https://doi.org/10.1097/MAT.0000000000002072
  • Bernheim SM, Ross JS, Krumholz HM, Bradley EH. Influence of patients’ socioeconomic status on clinical management decisions: a qualitative study. Ann Fam Med. 2008; 6(1): 53-59. doi: https://doi.org/10.1370/afm.749
  • Escarce JJ, Morales LS, Rumbaut RG. The health status and health behaviors of Hispanics. Washington (DC): National Academies Press (US); 2006.
  • Hill L, Artiga S. Health coverage among American Indian and Alaska Native and Native Hawaiian and other Pacific Islander people. KFF. [WWW]: https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-among-american-indian-and-alaska-native-andnativehawaiian-and-other-pacific-islander-people/ (accessed February 20, 2024)
  • Martono M, Fatmawati F, Mulyanti S. Risk factors associated with the severity of COVID-19. Malays J Med Sci. 2023; 30(3): 84-92. doi: https://doi.org/10.21315/mjms2023.30.3.7
  • McMaughan DJ, Oloruntoba O, Smith ML. Socioeconomic status and access to healthcare: interrelated drivers for healthy aging. Front Public Health. 2020; 8: 231. doi: https://doi.org/10.3389/fpubh.2020.00231

Document Type

Publication order reference

Identifiers

Biblioteka Nauki
55783225

YADDA identifier

bwmeta1.element.ojs-doi-10_32114_CCI_2024_7_2_12_19
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