Effect of Racial Disparities in the ICU
Summary written by Dr. Mustafa Abdulmahdi
Black Americans compared to white
- Increased mortality rates
- Earlier onset of illness
- Greater severity of illness
- Faster disease progression
Notes
- This disparity begins at birth! Black Americans have 2x the infant mortality compared to the rest of the country
- In the ICUà Black Americans tend to be sicker & younger on presentation, and have higher mortality rates
- In cardiac arrest, black Americans tend to be younger, get less bystander CPR and have fewer shockable rhythms, longer time to defibrillation, and longer time to ROSC
- Why is this happening?
- It’s not genetics – proportion of difference between people is small, based on ancestral group (only ~10 % variation); the rest of 90% variation is actually between groups on the same continents! Ancestry is a poor indicator of genetics.
- Institute of Medicine issued report on health disparities (1999) à health disparities based on race present in wide range of diseases & services persisted after controlling for socioeconomic status
- Interpersonal racism (almost never consciously done)
- Differential assumptions
- Differential actions
- Health care providers are at high risk of having bias à due to high cognitive demand and limitations in time, resources, information, and certainty
- Hospitals treating minority patients do a lot worse on a bunch of quality measures including CAP, ER length of stay and trauma mortality
- Institutional racism is differential access to good services and opportunity based on race à probably the biggest driver for health disparities
- What we’re doing better à health care reform; expanding access to quality care by broadening insurance coverage, reducing insurance inequality, & reducing access inequality
- Things we need to do:
- Increase minority participation in healthcare workforce, as they provide increased diversity & likely choose practice areas to serve minority patients
- Understand your own biases & practice on building cognitive skills
- Remove race from the patient’s presentation
- Advocate and speak up! Be a policy advocate, we need to reframe non-health policy topics, such as the Justice System, housing, schooling, & environment
