Increased mortality among acute respiratory distress patients from immigrant dense urban districts

Abstract

Purpose:

This study investigated whether living in immigrant dense urban districts (IDUDs) and low-income areas in the city of Malmö predicted 5-year mortality among patients admitted to the emergency department (ED) because of acute respiratory distress.

Patients and methods:

We randomly selected 184 patients with acute respiratory distress during 2007, visiting the ED at SkÃ¥ne University Hospital, Malmö. In 2007, Malmö had 36% first- and second-generation immigrants. The main exposure was defined as being resident in any of the five IDUDs of Malmö compared to being resident in the five districts of Malmö with the highest proportion of Sweden-born inhabitants (SDUDs). We recorded vital parameters; medical triage priority according to Adaptive Process Triage (ADAPT), ICD-10 diagnoses, and the mean annual income for the patientߣs urban district. We examined 5-year mortality risk using Cox proportional hazards model.

Results:

After adjustment for age and gender, patients from IDUDs (n=100, 54%) had an HR (95% CI) of 1.65 (1.087ߝ2.494; P=0.019) regarding mortality at 5-year follow-up. Patients in the lowest vs highest income quartile had an HR of 2.00 (1.06ߝ3.79; P=0.032) regarding mortality at 5-year follow-up. Age, male gender, presence of cardiopulmonary disease, and ADAPT priority also independently predicted the 5-year mortality. The excess risk of 5-year mortality associated with living in IDUDs remained significant after adjustment for age, gender, ADAPT priority, presence of cardiopulmonary disease, and income with an HR of 1.79 (1.15ߝ2.78; P=0.010).

Conclusion:

Living in an IDUD is a strong independent risk factor for 5-year mortality in patients with acute respiratory distress. The cause is unknown. Our study suggests a need for better structured follow-up of cardiopulmonary disease in such patients.

Keywords::

• dyspnea
• emergency department
• mortality
• socioeconomic
• income
• ADAPT

Ethics approval and consent to participate

This study has an ethical approval from Regionala Etikprövningsnämnden (EPN), Lund, Sweden Dnr 2014/82. The ethics committee has accepted that consent of participants was not asked for, as data were extracted from patientsߣ charts 5 years after their visit.

Consent for publication

This manuscript contains no individual personߣs data and therefore can be published without consent from the participants.

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

The study was supported by research grants from the Knut and Alice Wallenbergs Foundation, Göran Gustafsson Foundation, Swedish Heart-Lung Foundation, Swedish Research Council, Novo Nordisk Foundation, Region Skåne, SUH, and Swedish Foundation for Strategic Research (IRC). Special thanks to Mattias Wieloch, MD, PhD, former section manager, and Maria Ohlson Andersson, MD, present department manager, both at the ED, SUH, Malmö, Sweden, who contributed with support to make this study and paper possible.

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work. All authors read and approved the final manuscript.

Disclosure

The authors report no conflicts of interest in this work.