Almost half of low-income communities have no ICU beds to take care of seriously-ill Covid-19 patients: Study
While the shortage of intensive care unit (ICU) beds in the US has been documented since the pandemic began, researchers now show how starkly a person’s zip code affects access to Covid-19 care. About half of US communities with the lowest median household incomes, that is less than $35,000, have zero ICU beds per 10,000 residents aged 50 or older, compared with just 3% of communities with household incomes of at least $90,000. The study by University of Pennsylvania sheds light on yet another reason why the coronavirus pandemic is disproportionately killing the poor.
Researchers also found that ICU availability varied considerably across the country. More than one-third of American communities had zero ICU beds. Geographically, half of the hospital service areas in the Midwest census region and 34% in the West had zero ICU beds per 10,000 residents 50 or older. By contrast, 52% of hospital service areas in the Northeast and 54% in the South had more than four ICU beds per 10,000 residents 50 years and above.
Critical care units provide life support and high-tech equipment for patients with serious, life-threatening illnesses who require continuous care and monitoring. In the case of Covid-19, patients who are unable to breathe on their own require the ventilator support offered by an ICU to survive. For seriously ill patients, having access to an ICU is the difference between life and death, say researchers.
According to experts, inadequate access to ICU beds in low-income areas would exacerbate the health effects of Covid-19 on vulnerable populations that have disproportionately higher rates of coronavirus infection through greater job-related exposures, higher population density, more frequent use of mass transit, and less ability to quarantine. The combination of high infection rates, high rates of chronic health conditions, low access to testing, and inadequate critical care supply could result in very high Covid-19 death rates in low-income communities, they warn.
"The findings suggest that policymakers must take action, such as facilitating hospital sharing and publicly financing specialized resources. Because low-income communities face higher infection rates of the virus, as well as a higher prevalence of comorbidities -- which increases the risk of death from the disease — the low supply of ICU beds compounds the impact Covid-19 will have on these communities. Plans should be made for coordinating how hospitals can share these burdens," writes principal investigator of the study, Dr Genevieve P Kanter, in the analysis published in Health Affairs. Kanter is an assistant professor of medicine, medical ethics, and health policy in the Perelman School of Medicine, University of Pennsylvania.
The study sample consisted of the ICU bed capacity of 4,518 short-term and critical access hospitals in the 50 states and Washington, DC, obtained from the Centers for Medicare and Medicaid Services' Healthcare Provider Cost Reporting Information System. The researchers used the 2018 five-year American Community Survey estimates to gather information about population, age, racial distribution, and median household income. Instead of comparing ICU bed capacity by county or zip code, the researchers aggregated their data by hospital service area, which is defined as a set of zip codes corresponding to the area in which residents receive most of their hospital care. The analysis shows that residents in low-income neighborhoods lack access to intensive care unit (ICU) beds.
"There was a large gap in access by income: 49% of the lowest-income communities had no ICU beds in their communities, compared to only 3% of the highest income areas. Conversely, 46% of the lowest-income communities had an ICU bed supply of more than four beds per 10,000 residents, 50 or older, while a total of 59% of the highest-income places had more than four beds per 10,000. These differences were most pronounced in rural areas. Similar proportions of low, middle and high-income communities in cities had access to more than seven ICU beds per 10,000 residents, 50 or older, compared with communities in less urban areas," the findings state.
In light of the income disparities in community ICU bed supply, the researchers suggest measures that policymakers can take to mitigate potential harms. Individual hospitals facing severe Covid-19-related financial losses have little incentive to attract critically-ill patients from underserved areas, as these patients often lack extensive insurance coverage, and the costs of their care often exceed reimbursement rates. Therefore, the authors recommend that higher-level coordination is needed at the county, state, and federal levels to facilitate hospital sharing of the demand for care and to publicly finance specialized resources, such as ventilators and critical care doctors.
Researchers say that the typical emergency medical system guideline to "transport to the nearest hospital" should be revisited under these new pandemic conditions. They argue that the demand for Covid-19 and other care in low-income areas, whose residents are most adversely affected by the coronavirus, is straining hospitals in low-income areas.
Accordingly, plans should be made for how and under what conditions patients can be transported to hospitals outside their immediate communities and how these transport protocols will be communicated to the public, they suggest. "Emergency funds need to be directed toward hospitals lacking sufficient ICU resources, especially those caring for large older populations that are more likely to be hospitalized for Covid-19. As the Covid-19 pandemic progresses, coordinated policy responses are urgently needed to prevent preexisting socioeconomic disparities from exacerbating the harms already being done by Covid-19," write researchers.