Nearly half of low-income communities have no ICU beds in their area

By Juliet Isselbacher, STAT News, Aug 03, 2020.

As Covid-19 continues to strain the country’s hospital system, new research exposes a striking gap in access to ICU care from one community to the next.

The study, published Monday in Health Affairs, examined an area’s median household income compared to the number of ICU beds per 10,000 residents over 50 years old — the age cohort at greatest risk for Covid-19 hospitalization. Nearly half of the communities with a median income under $35,000 had no ICU beds at all in their ZIP code cluster, compared to only 3% of communities with a median income over $90,000.

The authors warn that the staggering scarcity of critical care services in low-income populations can exacerbate existing disparities seen in deaths due to Covid-19. Many low-income individuals are already at increased risk of infection because they are less likely to be able to work from home and may face more challenges in quarantining.

“What we find is that this low-income population is going to be doubly or triply hit,” said Genevieve Kanter, an assistant professor at the University of Pennsylvania Perelman School of Medicine and the first author of the study.

“Not only will there be higher infection rates, and worse outcomes due to underlying conditions, but also — once you get to the hospital — worse availability of the kind of care that you need,” she added.

In the earliest days after Covid-19 arrived in the U.S., confirmed cases were in people who had traveled to other parts of the world. But Kanter and her colleagues knew that if the virus were to start spreading locally, it might take a disproportionate toll on certain communities.

“What we saw coming down the pike was that eventually it was going to start hitting low-income populations,” she said.

The researchers wanted to prepare for that inevitability by taking formal stock of resources in those low-income areas. Gathering that data, they hoped, would arm policymakers with the information needed to protect the most vulnerable.

Now, with evidence of the disparities in ICU access, Kanter and her co-authors are urging state governments to step in and impose a patient transfer system to evenly distribute Covid-19 care among hospitals.

Another proposal: expand critical care capacity in low-income areas by temporarily outfitting procedural areas and other inpatient units with ICU beds, procured with emergency funds. The authors also suggested reconsidering the standard practice of transporting all patients to their nearest hospital, instead distributing those who are relatively stable to further locations with greater capacity.

“I do hope very much that people in state legislatures are paying attention to this,” said Nancy Beaulieu, a researcher in health care policy at Harvard Medical School who was not involved in the study.

The paper also found that this class-based disparity was far starker in rural areas than urban areas, a finding Beaulieu said was particularly notable.

“That’s a really important distinction because the health care delivery systems are very different in these areas. And the policy options for addressing disparities in these two types of areas are also likely to be quite different,” she said.

Beaulieu said researchers need to launch further studies into other disparities that affect low-income populations, such as a lack of access to specialists and fragmented coordination between speciality and primary care providers.

“Now that we have the attention on this issue, I think it’s very important to keep working at it and really come up with some actionable steps that we can take to improve the delivery systems,” she said.

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