Medicaid or uninsured status was associated with significantly higher ICU mortality compared to private insurance (27% vs 17%, p<0.01) among patients with acute respiratory failure.
Cohort (n=1,284)
Yes
Do socioeconomic status and race impact outcomes and pulmonary rehabilitation access in patients with acute respiratory failure?
Significant socioeconomic and racial disparities exist in acute respiratory failure care, with lower income and public/no insurance associated with higher ICU mortality and reduced access to pulmonary rehabilitation.
Absolute Event Rate: 27% vs 17%
p-value: p=<0.01
Abstract Socioeconomic and racial disparities continue to shape outcomes in critical illness. Patients with acute respiratory failure (ARF) often face inequitable access to timely interventions in the ICU and essential post-discharge recovery services such as pulmonary rehabilitation (PR). Disadvantaged populations may experience higher mortality, longer ICU stays, and lower PR referral rates, perpetuating a cycle of poor long-term outcomes. This study aimed to evaluate the association between socioeconomic status, race, and both inpatient and post-discharge outcomes among patients hospitalized with ARF. Methods A retrospective cohort study was conducted using electronic health record data from three tertiary hospitals between January 2020 and June 2024. Adults (≥18 years) admitted with acute hypoxemic or hypercapnic respiratory failure requiring ICU-level care were included. Patients were stratified by race/ethnicity (White, Black, Hispanic, Other) and insurance type (private, Medicare, Medicaid/uninsured). Socioeconomic status was estimated using ZIP-code median income quartiles from U.S. Census data. Primary ICU outcomes included in-hospital mortality and length of stay. Secondary outcomes included post-discharge pulmonary rehabilitation referral and completion within 90 days. Multivariable logistic regression adjusted for age, sex, illness severity, and comorbidities. Results A total of 1,284 patients were analyzed (mean age 62 ± 13 years; 49 % female; 31 % Black, 22 % Hispanic). ICU mortality was significantly higher among Medicaid/uninsured patients (27 %) compared with those privately insured (17 %, p 0.01). Median ICU length of stay was longer in the lowest income quartile (7.6 vs 5.8 days, p = 0.02). Among survivors, PR referral occurred in only 34 % overall, with stark disparities—22 % among Medicaid/uninsured vs 58 % privately insured (p 0.001). Completion of PR within 90 days was achieved by 9 % of Medicaid/uninsured and 28 % of privately insured patients (p 0.001). After adjustment, lower income (aOR 1.8; 95 % CI 1.3-2.4) and Black or Hispanic race (aOR 1.5; 95 % CI 1.1-2.2) independently predicted reduced PR participation. Conclusion Significant socioeconomic and racial disparities exist along the continuum of respiratory failure care—from higher ICU mortality to limited access to pulmonary rehabilitation. Lower income and public or no insurance was associated with worse acute outcomes and markedly reduced engagement in recovery programs. Addressing these inequities requires targeted care transitions, insurance reforms, and community-based outreach to ensure equitable recovery for all patients with respiratory failure. This abstract is funded by: none
Pugazhendi et al. (2026) conducted a cohort in Acute respiratory failure (n=1,284). Medicaid or uninsured status vs. Private insurance was evaluated on In-hospital mortality (p=<0.01). Medicaid or uninsured status was associated with significantly higher ICU mortality compared to private insurance (27% vs 17%, p<0.01) among patients with acute respiratory failure.