Racial and Geographic Disparities in Interhospital ICU Transfers

Patrick D. Tyler, David J. Stone, Benjamin P. Geisler, Stuart McLennan, Leo Anthony Celi, Barret Rush

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Objectives: Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred.

Design: Retrospective cohort study. Setting: Nationwide Inpatient Sample, 2006-2012.

Patients: Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation.

Interventions: None.

Measurements and Main Results: We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small-or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25).

Conclusions: In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.

Original languageEnglish
Pages (from-to)e76-e80
Number of pages5
JournalCritical Care Medicine
Issue number1
Publication statusPublished - 1 Jan 2018
Externally publishedYes


  • healthcare delivery
  • healthcare disparities
  • interhospital transfer
  • medical transport
  • sepsis


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