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Racial and Ethnic Differences in Oxygen Supplementation in the ICU
Quick Takes
- Self-reported Asian, Black, and Hispanic patients in the ICU receive less supplemental oxygen than White patients as a result of discrepancies in pulse oximeter performance.
- The impact of pulse oximeter performance discrepancies in different races and ethnicities and cardiac admissions and outcomes should be further examined.
Study Questions:
Are there differences in supplemental oxygen administration among patients of different races and ethnicities, and are these associated with discrepancies in pulse oximeter performance?
Methods:
This was a retrospective single-center cohort study of 3,069 patients identified from the Medical Information Mart for Intensive Care (MIMIC-IV) data set between 2008–2019. The primary outcome was time-weighted average supplemental oxygen rate. Multivariable linear regression was used to evaluate differences between races and ethnicities in pulse oximeter device performance, supplemental oxygen rates based on hemoglobin oxygen saturation or pulse oximetry (SpO2), and supplemental oxygen delivery explained by discrepancies between SpO2 and hemoglobin oxygen saturation.
Results:
The cohort included Asian (n = 83), Black (n = 207), Hispanic (n = 11), and White (n = 2,667) patients. The mean age was 66.9 (standard deviation 13.5) years and Sequential Organ Failure Assessment (SOFA) score components and laboratory values were overall well matched across races and ethnicities. Mortality rates for Asian, Black, Hispanic, and White patients were 3.6%, 8.2%, 7.1%, and 6.5%, respectively. Black, Hispanic, and Asian patients had a higher SpO2 than White patients (all p < 0.001) and were associated with a higher SpO2 for a given hemoglobin oxygen saturation, after controlling for covariates.
Multivariable linear regression showed a greater discrepancy between average SpO2 and average blood hemoglobin oxygen saturation resulted in lower supplemental oxygen delivery (p < 0.001) regardless of patient race and ethnicity. Asian, Black, or Hispanic race and ethnicity was not associated with a difference in oxygen delivery rate when controlling for the discrepancy between SpO2 and average hemoglobin oxygen saturation.
Conclusions:
This study showed that Asian, Black, and Hispanic patients in the intensive care unit (ICU) received less supplemental oxygen than White patients, and this finding was associated with differences in pulse oximeter performance.
Perspective:
This single-center cohort study associates pulse oximeter performance as a potential contributor to known race and ethnicity-based disparities in care. This study highlights the importance of utilizing multiple methods to assess oxygenation and educating clinicians on potential discrepancies in pulse oximeter performance in different self-reported racial and ethnic groups.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and ACS
Keywords: Acute Coronary Syndrome, Cardiac Surgical Procedures, Critical Care, Ethnic Groups, Geriatrics, Minority Health, Heart Failure, Hemoglobins, Intensive Care Units, Organ Dysfunction Scores, Oximetry, Oxygen Inhalation Therapy, Patient Care Team, Secondary Prevention
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