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Human Development Index and outcomes in older critically ill patients: A European multicentre study
Daniel Dankl1, Raphael Romano Bruno2, Michael Beil3
1Clinic of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, 5020, Salzburg Austria.
Annals of Intensive Care
|July 2, 2026
Summary
Older adults admitted to intensive care units (ICUs) in high human development index (HDI) countries had lower 30-day mortality. This suggests country-level development and ICU practices, like invasive ventilation, impact critical care outcomes.
Area of Science:
- Critical Care Medicine
- Global Health
- Health Economics
Background:
- Older adults are a growing demographic in intensive care units (ICUs).
- The impact of national human development on critical illness outcomes is not fully understood.
Purpose of the Study:
- To investigate the association between country-level human development and 30-day mortality in older ICU patients.
- To explore potential mediating factors in the relationship between human development and critical care outcomes.
Main Methods:
- Secondary analysis of three prospective multicenter registries (VIP1, VIP2, COVIP) of older ICU patients.
- Exposure: exceptionally high Human Development Index (HDI) (≥0.90) vs. lower HDI (<0.90).
- Outcome: 30-day mortality, analyzed using multivariable logistic regression, adjusting for patient and ICU factors.
Main Results:
- 9920 patients were analyzed; 83.9% were from high-HDI countries.
- 30-day mortality was lower in high-HDI countries (40.0%) compared to lower-HDI countries (53.3%).
- High HDI remained associated with lower mortality after multivariable adjustment (aOR 0.49) and continuous HDI modeling (OR 0.33 per 0.10-unit increase).
- Lower use of invasive mechanical ventilation in high-HDI countries was a potential mediator.
Conclusions:
- Treatment in high human development countries is linked to reduced 30-day mortality in older critically ill patients.
- Country-level development and ICU management, including ventilation strategies, may influence outcomes.
- Observational nature necessitates cautious interpretation of causality.
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