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Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0003-3067-8587
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.ORCID iD: 0000-0002-5903-2918
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2024 (English)In: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 80, article id 154497Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to examine relationships between education, income, and employment (socioeconomic status, SES) and intensive care unit (ICU) survival and survival 1 year after discharge from ICU (Post-ICU survival). Methods: Individual data from ICU patients were linked to register data of education level, disposable income, employment status, civil status, foreign background, comorbidities, and vital status. Associations between SES, ICU survival and 1-year post-ICU survival was analysed using Cox's regression. Results: We included 58,279 adults (59% men, median length of stay in ICU 4.0 days, median SAPS3 score 61). Survival rates at discharge from ICU and one year after discharge were 88% and 63%, respectively. Risk of ICU death (Hazard ratios, HR) was significantly higher in unemployed and retired compared to patients who worked prior to admission (1.20; 95% CI: 1.10-1.30 and 1.15; (1.07-1.24), respectively. There was no consistent association between education, income and ICU death. Risk of post-ICU death decreased with greater income and was roughly 16% lower in the highest compared to lowest income quintile (HR 0.84; 0.79-0.88). Higher education levels appeared to be associated with reduced risk of death during the first year after ICU discharge. Conclusions: Significant relationships between low SES in the critically ill and increased risk of death indicate that it is important to identify and support patients with low SES to improve survival after intensive care. Studies of survival after critical illness need to account for participants SES.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC , 2024. Vol. 80, article id 154497
Keywords [en]
Socioeconomic factors; Education; Income; Employment; Critical care outcomes; Mortality; Critical illness
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-200354DOI: 10.1016/j.jcrc.2023.154497ISI: 001136270500001PubMedID: 38086226Scopus ID: 2-s2.0-85179807661OAI: oai:DiVA.org:liu-200354DiVA, id: diva2:1830580
Note

Funding Agencies|Health Care Region County Council of Ostergotland, Sweden [LIO-702031]; Research Council in Southeast of Sweden (FORSS) [FORSS-559481]; Department of Anaesthesia and Intensive care, University Hospital of Linkoping, County Council of Ostergotland, Sweden

Available from: 2024-01-23 Created: 2024-01-23 Last updated: 2025-08-14

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Orwelius, LottiKristenson, MargaretaFredrikson, MatsSjöberg, FolkeWalther, Sten
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Division of Nursing Sciences and Reproductive HealthFaculty of Medicine and Health SciencesANOPIVA USDivision of Society and HealthEnheten för folkhälsaDivision of Inflammation and InfectionDivision of Surgery, Orthopedics and OncologyDepartment of Hand and Plastic SurgeryDepartment of Thoracic and Vascular Surgery
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