• Ronald Harris, Morgan Rosser, Anand M Chowdhury, Tetsu Ohnuma, Karthik Raghunathan, Krista L Haines, and Vijay Krishnamoorthy.
• Ronald Harris is a medical student, Duke University School of Medicine, Durham, North Carolina.
• Am. J. Crit. Care. 2024 Nov 1; 33 (6): 446454446-454.

BackgroundVarious social determinants of health have been established as significant risk factors for COVID-19 transmission, prevalence, incidence, and mortality. Area deprivation index (ADI, a composite score made up of educational, housing, and poverty markers) is an accepted multidimensional social determinants of health measure. Little is known about how structural social determinants of health before hospitalization, including ADI, may affect mortality related to COVID-19 in critically ill patients.ObjectivesTo examine the association of ADI with intensive care unit (ICU) mortality in patients with COVID-19 and compare its predictive power with that of clinical factors.MethodsThis was a retrospective cohort study of critically ill adults with COVID-19 in 3 hospitals within a single health system. Multivariable logistic regression models (adjusted for demographic and clinical variables) were used to examine the association of ADI with ICU mortality.ResultsData from 1784 patients hospitalized from 2020 to 2022 were analyzed. In multivariable models, no association was found between national ADI and ICU mortality. Notable factors associated with ICU mortality included treatment year, age, van Walraven weighted score, invasive mechanical ventilation, and body mass index.ConclusionIn this study, clinical factors were more predictive of mortality than ADI and other social determinants of health. The influence of ADI may be most relevant before hospital admission. These findings could serve as a foundation for shaping targeted public health strategies and hospital interventions, enhancing care delivery, and potentially contributing to better outcomes in future pandemics.©2024 American Association of Critical-Care Nurses.

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