J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 15, Number 10-11, December 2023, pages 438-445

Disparities in Palliative Care Among Critically Ill Patients With and Without COVID-19 at the End of Life: A Population-Based Analysis

**Table 1.** The Characteristics of ICU Patients With Sepsis During Terminal Hospitalization, With and Without COVID-19
Variables	COVID-19^a	Non-COVID-19^a	P value
^aThe parenthesized figures represent percents, except for Deyo comorbidity index and number of organ dysfunctions. ^bMean (standard deviation). Percentage figures may not add to 100 due to rounding. COVID-19: coronavirus virus disease 2019; ICU: intensive care unit.
Age, years			< 0.0001
18 - 44	516 (5.6)	860 (7.8)
45 - 64	3,092 (33.6)	3,537 (32.8)
≥ 65	5,598 (60.8)	6,641 (60.2)
Gender
Female	3,489 (37.9)	5,199 (47.1)	< 0.0001
Race/ethnicity			< 0.0001
White	3,112 (33.8)	5,798 (52.5)
Hispanic	4,258 (46.3)	2,571 (23.3)
Black	974 (10.6)	1,680 (15.2)
Other	862 (9.4)	989 (9.0)
Health insurance			< 0.0001
Private	4,354 (47.3)	4,380 (39.7)
Medicare	3,149 (34.2)	4,497 (40.7)
Medicaid	535 (5.8)	832 (7.5)
Uninsured	631 (6.9)	1,084 (9.8)
Other	537 (5.8)	245 (2.2)
Deyo comorbidity index^b	1.8 (2.0)	3.4 (2.7)	< 0.0001
Selected comorbidities
Chronic lung disease	1,599 (17.4)	2,348 (21.3)	< 0.0001
Congestive heart failure	2,259 (24.5)	4,294 (38.9)	< 0.0001
Renal disease	2,814 (30.6)	3,714 (33.6)	< 0.0001
Diabetes	5,084 (55.2)	4,239 (38.4)	< 0.0001
Malignancy	400 (4.3)	2,319 (21.0)	< 0.0001
Liver disease	508 (5.5)	1,516 (13.7)	< 0.0001
Number of organ dysfunctions^b	3.8 (1.2)	4.0 (1.3)	< 0.0001
Type of organ dysfunctions
Respiratory	9,058 (98.4)	9,594 (86.9)	< 0.0001
Cardiovascular	8,094 (87.9)	10,102 (91.5)	< 0.0001
Renal	7,115 (77.3)	8,104 (73.4)	< 0.0001
Hepatic	1,137 (12.4)	2,354 (21.3)	< 0.0001
Hematological	2,555 (24.5)	3,376 (30.6)	< 0.0001
Neurological	2,998 (32.6)	5,035 (45.6)	< 0.0001
Mechanical ventilation	5,725 (62.2)	6,072 (55.0)	< 0.0001
Hemodialysis	1,511 (16.4)	1,785 (16.2)	0.7012
Teaching hospital	2,834 (30.8)	3,627 (32.9)	0.0014
Palliative care	2,948 (32.0)	4,096 (37.1)	< 0.0001

Table 1. The Characteristics of ICU Patients With Sepsis During Terminal Hospitalization, With and Without COVID-19

Variables

COVID-19^a

Non-COVID-19^a

P value

(N = 9,206)

(N = 11,038)

^aThe parenthesized figures represent percents, except for Deyo comorbidity index and number of organ dysfunctions. ^bMean (standard deviation). Percentage figures may not add to 100 due to rounding. COVID-19: coronavirus virus disease 2019; ICU: intensive care unit.

Age, years

< 0.0001

18 - 44

516 (5.6)

860 (7.8)

45 - 64

3,092 (33.6)

3,537 (32.8)

≥ 65

5,598 (60.8)

6,641 (60.2)

Gender

Female

3,489 (37.9)

5,199 (47.1)

< 0.0001

Race/ethnicity

< 0.0001

White

3,112 (33.8)

5,798 (52.5)

Hispanic

4,258 (46.3)

2,571 (23.3)

Black

974 (10.6)

1,680 (15.2)

Other

862 (9.4)

989 (9.0)

Health insurance

< 0.0001

Private

4,354 (47.3)

4,380 (39.7)

Medicare

3,149 (34.2)

4,497 (40.7)

Medicaid

535 (5.8)

832 (7.5)

Uninsured

631 (6.9)

1,084 (9.8)

Other

537 (5.8)

245 (2.2)

Deyo comorbidity index^b

1.8 (2.0)

3.4 (2.7)

< 0.0001

Selected comorbidities

Chronic lung disease

1,599 (17.4)

2,348 (21.3)

< 0.0001

Congestive heart failure

2,259 (24.5)

4,294 (38.9)

< 0.0001

Renal disease

2,814 (30.6)

3,714 (33.6)

< 0.0001

Diabetes

5,084 (55.2)

4,239 (38.4)

< 0.0001

Malignancy

400 (4.3)

2,319 (21.0)

< 0.0001

Liver disease

508 (5.5)

1,516 (13.7)

< 0.0001

Number of organ dysfunctions^b

3.8 (1.2)

4.0 (1.3)

< 0.0001

Type of organ dysfunctions

Respiratory

9,058 (98.4)

9,594 (86.9)

< 0.0001

Cardiovascular

8,094 (87.9)

10,102 (91.5)

< 0.0001

Renal

7,115 (77.3)

8,104 (73.4)

< 0.0001

Hepatic

1,137 (12.4)

2,354 (21.3)

< 0.0001

Hematological

2,555 (24.5)

3,376 (30.6)

< 0.0001

Neurological

2,998 (32.6)

5,035 (45.6)

< 0.0001

Mechanical ventilation

5,725 (62.2)

6,072 (55.0)

< 0.0001

Hemodialysis

1,511 (16.4)

1,785 (16.2)

0.7012

Teaching hospital

2,834 (30.8)

3,627 (32.9)

0.0014

Palliative care

2,948 (32.0)

4,096 (37.1)

< 0.0001

**Table 2.** Sensitivity Analyses of the Use of Palliative Care Among ICU Patients With Sepsis During Terminal Hospitalization, With and Without COVID-19
Patient group	aOR (95% CI)^{a, b}	P value
^aAdjusted odds ratio (aOR) and 95% confidence interval (CI); Patients without COVID-19 were used as reference group. ^bAll estimates are based on multivariable logistic regression models. Models of younger patients, males, racial/ethnic minorities, those undergoing mechanical ventilation, those with ≥ 3 organ dysfunctions, and those admitted to teaching hospitals were performed after exclusion of age, gender, race/ethnicity, mechanical ventilation, organ dysfunction, and hospitals’ teaching status, respectively. COVID-19: coronavirus virus disease 2019; ICU: intensive care unit.
Age < 65 years	0.72 (0.64 - 0.80)	< 0.0001
Male	0.81 (0.74 - 0.88)	< 0.0001
Racial/ethnic minority	0.86 (0.79 - 0.94)	0.0017
Mechanical ventilation	0.86 (0.78 - 0.93)	0.0006
≥ 3 organ dysfunctions	0.85 (0.79 - 0.91)	< 0.0001
Teaching hospital	0.84 (0.75 - 0.95)	0.0054

Table 2. Sensitivity Analyses of the Use of Palliative Care Among ICU Patients With Sepsis During Terminal Hospitalization, With and Without COVID-19

Patient group

aOR (95% CI)^{a, b}

P value

^aAdjusted odds ratio (aOR) and 95% confidence interval (CI); Patients without COVID-19 were used as reference group. ^bAll estimates are based on multivariable logistic regression models. Models of younger patients, males, racial/ethnic minorities, those undergoing mechanical ventilation, those with ≥ 3 organ dysfunctions, and those admitted to teaching hospitals were performed after exclusion of age, gender, race/ethnicity, mechanical ventilation, organ dysfunction, and hospitals’ teaching status, respectively. COVID-19: coronavirus virus disease 2019; ICU: intensive care unit.

Age < 65 years

0.72 (0.64 - 0.80)

< 0.0001

Male

0.81 (0.74 - 0.88)

< 0.0001

Racial/ethnic minority

0.86 (0.79 - 0.94)

0.0017

Mechanical ventilation

0.86 (0.78 - 0.93)

0.0006

≥ 3 organ dysfunctions

0.85 (0.79 - 0.91)

< 0.0001

Teaching hospital

0.84 (0.75 - 0.95)

0.0054