Association Between Socioeconomic Status and Outcomes in Critical Care: A Systematic Review and Meta-Analysis

Abstract

Objectives: Socioeconomic status is well established as a key determinant of inequalities in health outcomes. Existing literature examining the impact of socioeconomic status on outcomes in critical care has produced inconsistent findings. Our objective was to synthesize the available evidence on the association between socioeconomic status and outcomes in critical care. Data Sources: A systematic search of CINAHL, Ovid MEDLINE, and EMBASE was undertaken on September 13, 2022. Study Selection: Observational cohort studies of adults assessing the association between socioeconomic status and critical care outcomes including mortality, length of stay, and functional outcomes were included. Two independent reviewers assessed titles, abstracts, and full texts against eligibility and quality criteria. Data Extraction: Details of study methodology, population, exposure measures, and outcomes were extracted. Data Synthesis: Thirty-eight studies met eligibility criteria for systematic review. Twenty-three studies reporting mortality to less than or equal to 30 days following critical care admission, and eight reporting length of stay, were included in meta-analysis. Random-effects pooled analysis showed that lower socioeconomic status was associated with higher mortality at less than or equal to 30 days following critical care admission, with pooled odds ratio of 1.13 (95% CIs, 1.05–1.22). Meta-analysis of ICU length of stay demonstrated no significant difference between socioeconomic groups. Socioeconomic status may also be associated with functional status and discharge destination following ICU admission. Conclusions: Lower socioeconomic status was associated with higher mortality following admission to critical care.