Social determinants of health (SDOH) are increasingly recognized as drivers of critical care outcomes but remain understudied in venoarterial extracorporeal membrane oxygenation (VA ECMO). We examined whether neighborhood-level SDOH were associated with 30 day post-discharge survival and prolonged length of stay (LOS) among VA ECMO patients. We retrospectively analyzed VA ECMO patients treated at Johns Hopkins Hospital, linking geocoded addresses to 12-digit Federal Information Processing Standards (FIPS) codes, 2022 American Community Survey data, 2023 Area Deprivation Index (ADI), and PolicyMap metrics. The primary outcome was 30 day mortality from discharge; secondary outcome was prolonged LOS (> 38 days, median among survivors). Multivariable logistic regression adjusted for preselected variables. Among 266 VA ECMO patients (median age: 59.50, 59% male), the median ADI percentile was 31.00, and LOS was 20.50 days. At 30 days, non-survivors (n = 133) were older (62 vs. 55 years, p = 0.002) and had higher body mass index (34.7 vs. 25.2, p < 0.001). Prolonged LOS was associated with longer ECMO duration, higher neighborhood insurance coverage, and greater commuting by car. In adjusted models, SDOH were not associated with mortality, but higher insurance coverage remained associated with prolonged LOS. Clinical factors influenced short-term survival, whereas neighborhood-level SDOH may affect discharge. Future studies should evaluate SDOH in long-term recovery. https://links.lww.com/ASAIO/B925.
Fan et al. (Wed,) studied this question.
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