Association between patient race/ethnicity and invasive ventilation in hypoxemic respiratory failure
Bibliographic record
Abstract
Abstract Importance Differential use of therapies for respiratory failure according to patient race/ethnicity may represent health inequity and could impact patient survival. Objective Measure the association between patient race/ethnicity and the use of invasive ventilation, and the impact of any association on survival. Design Retrospective cohort analysis using a Bayesian multistate model that adjusted for baseline covariates and time-varying severity. Setting Multicenter study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) and Phillips eICU (eICU) databases from the USA. Participants Non-intubated adults receiving oxygen within the first 24 hours of ICU admission. Exposure Patient race/ethnicity (Asian, Black, Hispanic, white). Main outcomes and measures Primary output was the cause-specific hazard ratio (HR) of invasive ventilation for patient race/ethnicity. Secondary output was change in 28-day survival mediated by differences in invasive ventilation rate. We reported posterior means and 95% credible intervals (CrI). Results We studied 38,263 patients, 52% (20,033) from MIMIC-IV and 48% (18,230) from eICU, 2% Asian (892), 11% Black (4,289), 5% Hispanic (1,964), and 81% white (31,923). Invasive ventilation occurred in 3,511 (9.2%), and 2,869 (7.5%) died. The rate of invasive ventilation was lower in Asian (HR 0.82, CrI 0.70 to 0.95), Black (HR 0.78, CrI 0.71 to 0.86), and Hispanic (HR 0.70, CrI 0.61 to 0.79) patients as compared to white patients. For the average patient, lower rates of invasive ventilation did not mediate differences in survival. For a reference patient with inspired oxygen (FiO2) varied from 0.5 to 1.0, the change in survival mediated by lower rates of invasive ventilation ranged from probable benefit (probability 0.82 for Asian patients, 0.91 for Black patients, and 0.93 for Hispanic patients) at FiO2 0.5 to probable harm (probability 0.87 for Asian patients, 0.92 for Black patients, and 0.97 for Hispanic patients) at FiO2 1.0, although the mean absolute changes in mortality were all less than 1.5%. Conclusions Asian, Black, and Hispanic patients had a lower rate of invasive ventilation than white patients. The changes in 28-day survival mediated by this difference ranged from slight benefit at lower inspired oxygen fractions to slight harm at inspired oxygen fraction of 1.0, and there was no difference in survival for the average patient. Key Points Question What is the association between patient race/ethnicity and the use of invasive ventilation in hypoxemic respiratory failure, and what is the impact of any differences on survival? Findings We studied 38,263 patients from two US databases, who were 2% Asian (892), 11% Black (4,289), 5% Hispanic (1,964), and 81% white (31,118). Invasive ventilation occurred in 3,511 (9.2%), and 2,869 (7.5%) died. The hazard ratio (HR) for invasive ventilation was lower in Asian (HR 0.82, CrI 0.70 to 0.95), Black (HR 0.78, CrI 0.71 to 0.86), and Hispanic (HR 0.70, CrI 0.61 to 0.79) patients as compared to white patients. For the average patient, race/ethnicity differences in invasive ventilation rates did not mediate differences in 28-day survival. For the reference patient, at inspired oxygen fractions up to 0.9, lower invasive ventilation rates mediated a modest survival benefit, whereas at inspired oxygen fraction of 1.0, the lower invasive ventilation rates mediated a modest survival decrease, although the absolute changes were all less than 1.5%. Meaning Asian, Black, and Hispanic patients had a lower rate of invasive ventilation than white patients. Although this difference had no impact on 28-day survival for the average patient, the change in survival mediated by lower rates of invasive ventilation could range from slight benefit at lower inspired oxygen fractions to slight harm at inspired oxygen fraction of 1.0.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".