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A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems

Bernhard Wernly, Hans Flaatten, Michael Beil, Jesper Fjølner, Raphael Romano Bruno, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Malte Kelm, Sviri Sigal, et al.
(2022) SCIENTIFIC REPORTS. 12(1).
Author
Organization
Abstract
In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged >= 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill >= 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 +/- 3 vs. 5 +/- 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40-0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients >= 70 years with COVID-19 in Europe.
Keywords
Multidisciplinary

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MLA
Wernly, Bernhard, et al. “A Retrospective Cohort Study Comparing Differences in 30-Day Mortality among Critically Ill Patients Aged ≥ 70 Years Treated in European Tax-Based Healthcare Systems (THS) versus Social Health Insurance Systems.” SCIENTIFIC REPORTS, vol. 12, no. 1, Springer Science and Business Media LLC, 2022, doi:10.1038/s41598-022-21580-y.
APA
Wernly, B., Flaatten, H., Beil, M., Fjølner, J., Bruno, R. R., Artigas, A., … Jung, C. (2022). A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems. SCIENTIFIC REPORTS, 12(1). https://doi.org/10.1038/s41598-022-21580-y
Chicago author-date
Wernly, Bernhard, Hans Flaatten, Michael Beil, Jesper Fjølner, Raphael Romano Bruno, Antonio Artigas, Bernardo Bollen Pinto, et al. 2022. “A Retrospective Cohort Study Comparing Differences in 30-Day Mortality among Critically Ill Patients Aged ≥ 70 Years Treated in European Tax-Based Healthcare Systems (THS) versus Social Health Insurance Systems.” SCIENTIFIC REPORTS 12 (1). https://doi.org/10.1038/s41598-022-21580-y.
Chicago author-date (all authors)
Wernly, Bernhard, Hans Flaatten, Michael Beil, Jesper Fjølner, Raphael Romano Bruno, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Malte Kelm, Sviri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Richard Rezar, Sandra Oeyen, Georg Wolff, Brian Marsh, Finn H. Andersen, Rui Moreno, Sarah Wernly, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, Stefan Perings, and Christian Jung. 2022. “A Retrospective Cohort Study Comparing Differences in 30-Day Mortality among Critically Ill Patients Aged ≥ 70 Years Treated in European Tax-Based Healthcare Systems (THS) versus Social Health Insurance Systems.” SCIENTIFIC REPORTS 12 (1). doi:10.1038/s41598-022-21580-y.
Vancouver
1.
Wernly B, Flaatten H, Beil M, Fjølner J, Bruno RR, Artigas A, et al. A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems. SCIENTIFIC REPORTS. 2022;12(1).
IEEE
[1]
B. Wernly et al., “A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems,” SCIENTIFIC REPORTS, vol. 12, no. 1, 2022.
@article{01GS7QPM2486CTYP5Q0ET3DYNY,
  abstract     = {{In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged >= 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill >= 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 +/- 3 vs. 5 +/- 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40-0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients >= 70 years with COVID-19 in Europe.}},
  articleno    = {{17460}},
  author       = {{Wernly, Bernhard and Flaatten, Hans and Beil, Michael and Fjølner, Jesper and Bruno, Raphael Romano and Artigas, Antonio and Pinto, Bernardo Bollen and Schefold, Joerg C. and Kelm, Malte and Sigal, Sviri and van Heerden, Peter Vernon and Szczeklik, Wojciech and Elhadi, Muhammed and Joannidis, Michael and Rezar, Richard and Oeyen, Sandra and Wolff, Georg and Marsh, Brian and Andersen, Finn H. and Moreno, Rui and Wernly, Sarah and Leaver, Susannah and Boumendil, Ariane and De Lange, Dylan W. and Guidet, Bertrand and Perings, Stefan and Jung, Christian}},
  issn         = {{2045-2322}},
  journal      = {{SCIENTIFIC REPORTS}},
  keywords     = {{Multidisciplinary}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{9}},
  publisher    = {{Springer Science and Business Media LLC}},
  title        = {{A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems}},
  url          = {{http://doi.org/10.1038/s41598-022-21580-y}},
  volume       = {{12}},
  year         = {{2022}},
}
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