228: Trends in Short-Term Mortality in Critically Ill Patients With Covid-19 by Race and Ethnicity

Introduction: Racial and ethnic minority status has been associated with increased risk of COVID-19-related critical illness, but evidence has been mixed on the prognostic impact of race and ethnicity among the critically ill. We examined the comparative trends in short-term mortality across race and ethnicity strata of critically ill patients with COVID-19. Methods: We used a statewide dataset to identify ICU admissions aged ≥18 years with a principal diagnosis of COVID-19 in Texas, from April 1, 2020 to December 31, 2023. COVID-19 was defined as ICD-10 code U071. Hierarchical logistic models were fit to estimate the association of time (quarters) with short-term mortality (defined as in-hospital death or discharge to hospice) among critically ill COVID-19 patients. Interaction terms were included between each racial and ethnic minority group (with Whites as reference) and time overall and on sensitivity analyses of older adults and the mechanically ventilated. Results: There were 164,719 ICU admissions with COVID-19 (49.1% aged ≥65 years; 44.4% female; 52.4% racial and ethnic minorities [32.3% Hispanics, 12.2% Blacks, 7.9% Other]). Overall short-term mortality was 20.0%. On adjusted analyses, short-term mortality decreased over time among Hispanics (adjusted odds ratio [aOR] 0.97/quarter [95% CI 0.96-0.98]) and Whites (aOR 0.94/quarter [95% CI 0.93-0.95]), but not among Blacks (aOR 0.98/quarter [95% CI 0.96-1.01]) or Other minorities (aOR 0.98/quarter [95% CI 0.96-1.01]). There were significant interactions among all race and ethnicity minorities (vs Whites) and time overall, but not among those aged ≥65 years or the mechanically ventilated. Compared to Whites, short-term mortality was higher over time among Hispanic ICU admissions (aOR/quarter 1.03 [95% CI 1.01-1.04]). Conclusions: Short-term mortality among critically ill patients with COVID-19 has decreased over time among White and Hispanic people, but not among Black individuals or Other racial and ethnic minorities. However, even among Hispanic individuals, these outcome gains were not shared equitably compared to Whites. Further studies are needed to examine the factors underlying the divergence of outcome trajectories across racial and ethnic groups among critically ill patients with COVID-19 during the latter pandemic years.