Critical care medicine
July 21, 2026 · via Europe PMC
Socioeconomic Disparities and the Role of Comorbidity in Hospital Mortality: A Dutch Nationwide Critical Care Cohort Study.
de Kok JWTM, Koornneef DJM, Termorshuizen F, Schnabel RM, van der Horst ICC, de Keizer NF, Brinkman S, van Bussel BCT.
AI summary — for doctors, generated from the abstract only
Lower socioeconomic status was associated with higher hospital mortality in Dutch ICU patients regardless of comorbidity.
What was studied
Nationwide retrospective cohort of 588,568 ICU admissions (2014 to 2022) linked to household SES, using mixed-effects logistic regression adjusted for age, sex, severity and comorbidities.
Key findings
- Unadjusted mortality odds were higher for lower SES
- After adjustment, ORs relative to the middle quintile were 1.6 (1.5-1.6), 1.1 (1.0-1.1), 1.0 (0.9-1.0) and 0.9 (0.9-1.0) across quintiles as reported
- The association was strongest in the lowest SES quintile and persisted with and without specific comorbidities
Clinical relevance
Socioeconomic disparities in ICU survival persist even in a universal-insurance system and should inform outcome interpretation and equity policy.
Who should care
Limitations
Retrospective and observational; residual confounding likely; the order of the quintiles listed is not fully specified in the abstract.
Lower SES carries worse ICU survival even after adjustment.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
Lower socioeconomic status (SES) is associated with a higher prevalence of comorbidities and mortality. The association between SES and mortality, as well as the effect-modifying role of specific comorbidities, are not yet fully understood within the critical care context of insurance-based universal healthcare systems. To inform health policy and practice, we examined socioeconomic disparities in Dutch ICU admissions, considering comorbidities in the context of hospital mortality.
Design
Nationwide retrospective cohort study.
Setting
All 79 Dutch ICUs were included.
Patients
We used data from 588,568 ICU admissions (2014-2022) linked with household-level SES data.
Interventions
None.
Measurements and main results
We used mixed-effects logistic regression models to investigate the association between SES quintiles and hospital mortality. We adjusted models for age, sex, year of admission, acute physiologic derangement, and comorbidities. Also, we investigated the effect-modifying role of seven comorbidities: respiratory insufficiency, renal insufficiency, cancer, cardiovascular insufficiency, diabetes mellitus, cirrhosis, and immunological insufficiency. Unadjusted odds ratios (ORs) for hospital mortality were higher among patients with lower SES. After adjustment, SES quintiles remained significantly different from the middle quintile, with attenuated ORs (95% CI): 1.6 (1.5-1.6), 1.1 (1.0-1.1), 1.0 (0.9-1.0), and 0.9 (0.9-1.0), respectively. The association was most pronounced in the lowest SES quintile and persisted in patients with and without specific comorbidities.
Conclusions
ICU patients with a lower SES face poorer survival prospects, irrespective of comorbidities. This highlights the persistent health disparities that may influence ICU outcomes. SES should be considered for interpreting outcome measures, designing healthcare policies, and targeting interventions to improve health equity.
DOI
10.1097/ccm.0000000000007271
PMID
42479534
PMCID
PMC13632809
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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