Rurality and long-term outcomes after critical illness

Area of Science:

• Critical illness recovery
• Rural health outcomes
• Post-ICU care

Background:

• The influence of rurality on recovery after critical illness remains largely unexplored.
• Understanding these disparities is crucial for equitable healthcare.
• Rural populations may face unique challenges in accessing post-ICU care and rehabilitation.

Purpose of the Study:

• To investigate the association between rurality and outcomes in intensive care unit (ICU) survivors.
• To assess the impact of rurality on disability, cognitive function, and health-related quality of life.
• To determine if area-level socioeconomic deprivation modifies these rurality-outcome associations.

Main Methods:

• Utilized Rural-Urban Commuting Area (RUCA) codes to quantify rurality.
• Assessed disability (basic and instrumental activities of daily living), cognitive function, and quality of life at 3 and 12 months post-discharge.
• Employed multivariable regression with inverse probability of attrition weighting, adjusting for the Area Deprivation Index (ADI) and other covariates.

Main Results:

• Greater rurality was significantly associated with increased odds of disability in basic activities of daily living at 3 months (aOR: 2.16) and 12 months post-discharge.
• No significant association was found between rurality and cognitive function or health-related quality of life.
• No interaction was observed between rurality (RUCA) and socioeconomic deprivation (ADI) for basic activities of daily living.

Conclusions:

• Increased rurality is a significant risk factor for disability in basic activities of daily living among critical illness survivors.
• Rural living does not appear to impact cognitive function or quality of life post-ICU.
• Socioeconomic deprivation does not appear to modify the relationship between rurality and basic ADL disability.