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Ethics and End of LIfe

Star Research Presentations: Health Disparities

End-of-Life Care Disparities in the Intensive Care Unit: A MIMIC-IV Database Evaluation

Monday, February 24, 2025
10:10am – 10:55am Eastern Time
Location: Connections Central Theater 1

  • Namrata Patil, MD, MPH (she/her/hers)

    Brigham & Women's Hospital

    Disclosure(s): Alphabet: Major Stockholder (not including mutual funds) (Ongoing); Apple: Major Stockholder (not including mutual funds) (Ongoing); Microsoft: Major Stockholder (not including mutual funds) (Ongoing); Society of Critical Care Medicine: Grants/Research Support Recipient (Terminated); Tesla: Major Stockholder (not including mutual funds) (Ongoing)

  • XZ

    Xiaohan Tanner Zhang, M.D., M.S.

    Senior Research Data Analyst
    Johns Hopkins Medicine

    Disclosure information not submitted.

  • MG

    Mayank Garg, M.B.B.S., Ph.D., PGDMLE

    Fellow
    Ashoka University

    Disclosure information not submitted.

  • NM

    Nikita Mullangi, N/A

    Student
    n/a

    Disclosure information not submitted.

  • KW

    Kyle Weant, BCCCP, BCPS, PharmD

    Clinical Adjunct Professor
    University of South Carolina College of Pharmacy

    Disclosure information not submitted.

  • Andrew Barros, MD, MS (he/him/his)

    Assistant Professor, Department of Medicine Division of Pulmonary and Critical Care
    University of Virginia

    Disclosure information not submitted.

Disclosure(s):
Namrata Patil, MD, MPH: Alphabet: Major Stockholder (not including mutual funds) (Ongoing); Apple: Major Stockholder (not including mutual funds) (Ongoing); Microsoft: Major Stockholder (not including mutual funds) (Ongoing); Society of Critical Care Medicine: Grants/Research Support Recipient (Terminated); Tesla: Major Stockholder (not including mutual funds) (Ongoing)
Introduction: The extent of potential disparities in end-of-life (EOL) care for patients in the Intensive Care Unit (ICU) is not well described. We aimed to identify if potential racial, ethnic, and non-English language preference (NELP) disparities in care may exist at the EOL in critically ill patients. This work was performed at the 2024 Society of Critical Care Medicine Datathon in Chicago, Il.


Methods: Patient data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) was collected for those admitted to the ICU from 2008 to 2019. Patients who died or were discharged to hospice care and were admitted to ICU were included in this study. Aggressive EOL care was defined as receiving mechanical ventilation, vasopressor therapy, or renal replacement therapy within 4 hours of the terminal event. Pharmacotherapy at EOL was defined as receiving morphine or hydromorphone within 2 hours of the terminal event as an indicator of comfort care.


Results: A total of 7,974 patients were included in our analysis. Median day 1 Sequential Organ Failure Assessment (SOFA) score was 7 and majority of patients were admitted to medical service (75%). About 64% of the cohort self-identified their race as white and 9.1% self-identified as Black. Patients with a NELP were significantly more likely to receive mechanical ventilation at EOL (OR 1.28 [95% CrI 1.05, 1.56]) and those self-identified as Black were significantly more likely to receive vasopressors at EOL (OR 1.26 [95% CrI 1.01, 1.57]). Patients with a NELP or self-identified as Black were significantly less likely to receive EOL pharmacotherapy (OR 0.64 [95% CrI 0.55, 0.75], 0.76 [95% CrI 0.64, 0.89]).


Conclusions: Minority and NELP patients appeared to have significantly more aggressive, life sustaining EOL care as compared to their white counterparts. In addition, minority and NELP patients were also less likely to receive EOL pharmacotherapy comfort care measures. This could be attributed to potential communication delays caused by language barriers. This needs to be further evaluated and validated in future studies.