(316) Social Determinants of Health and Delirium Occurrence in ICU Patients

Introduction: Social determinants of health (SDoH) may negatively affect outcomes for patients in the intensive care unit (ICU); however, their influence on development of ICU-related delirium is not well established. We sought to investigate the association between SDoH and the incidence of ICU delirium.

Methods: This single-center IRB-approved retrospective review included adult patients (≥ 18 years) admitted to the medical ICU between January 2022 and September 2023 who required invasive mechanical ventilation within 24 hours of ICU admission for at least 48 hours and survived until ICU discharge. Patients with baseline delirium, history of psychotic disorder, treatment for alcohol withdrawal, chronic ventilation, antipsychotic use prior to admission, or deep sedation throughout the entire ICU stay were excluded. Delirium was defined as a positive CAM-ICU or scheduled antipsychotic use. SDoH assessed included ethnicity, race, primary language, insurance type, and neighborhood’s socioeconomic disadvantage based on area deprivation index. Cox proportional hazards regression was used to identify variables associated with delirium, adjusted for pertinent ICU covariates. Zero-inflated Poisson regression was used to assess factors associated with the duration of delirium.

Results: Among a total of 127 patients included, 32% identified as African American and 54% as non-Hispanic or Latino. English was the primary language for 72% and 91% had government insurance. Delirium occurred in 61 patients (48%). Baseline characteristics were similar between patients that experienced delirium and those that did not. Race, ethnicity, neighborhood, and primary language were not associated with the development of delirium. Adjusting for covariates, patients with private insurance had a higher likelihood of developing delirium compared to those with government insurance (aOR 3.25, 95% CI: 1.06-9.96, p=0.04). Conversely, delirium duration was significantly shorter in patients with private insurance compared to those with government insurance (aOR 0.34, 95% CI: 0.13-0.84; p=0.02).

Conclusions: Race, ethnicity, primary language, and neighborhood did not show association with the development of ICU delirium. More patients with private insurance developed delirium but duration of delirium was shorter.