A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems

Bernhard Wernly, Hans Flaatten, Michael Beil, Jesper Fjølner, Raphael Romano Bruno, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Malte Kelm, Sviri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Richard Rezar, Sandra Oeyen, Georg Wolff, Brian Marsh, Finn H. Andersen, Rui MorenoSarah Wernly, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, Stefan Perings, Christian Jung

Research output: Contribution to journalArticlepeer-review

2 Downloads (Pure)

Abstract

In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40–0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe.

Original languageEnglish
Article number17460
JournalScientific Reports
Volume12
Issue number1
DOIs
Publication statusPublished - 12 Oct 2022

Fingerprint

Dive into the research topics of 'A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems'. Together they form a unique fingerprint.

Cite this