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Human Development Index and outcomes in older critically ill patients

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dc.contributor.authorDankl, Daniel
dc.contributor.authorBruno, Raphael Romano
dc.contributor.authorBeil, Michael
dc.contributor.authorFlaatten, Hans
dc.contributor.authorKelm, Malte
dc.contributor.authorSigal, Sviri
dc.contributor.authorSzczeklik, Wojciech
dc.contributor.authorElhadi, Muhammed
dc.contributor.authorJoannidis, Michael
dc.contributor.authorKoköfer, Andreas
dc.contributor.authorSchreiber, Barbara
dc.contributor.authorSinghartinger, Franz
dc.contributor.authorOeyen, Sandra
dc.contributor.authorMarsh, Brian
dc.contributor.authorMoreno, Rui
dc.contributor.authorLeaver, Susannah
dc.contributor.authorDe Lange, Dylan W.
dc.contributor.authorGuidet, Bertrand
dc.contributor.authorBoumendil, Ariane
dc.contributor.authorJung, Christian
dc.contributor.authorWernly, Bernhard
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblSpringer Verlag
dc.date.accessioned2026-07-14T09:16:02Z
dc.date.available2026-07-14T09:16:02Z
dc.date.issued2026
dc.descriptionPublisher Copyright: © 2026 The Author(s).
dc.description.abstractBackground Older adults represent an increasing proportion of intensive care unit admissions, but the relationship between country-level human development and outcomes after critical illness remains incompletely understood. Methods We conducted a secondary analysis of three prospective multicentre registries, VIP1, VIP2, and COVIP, including acutely admitted older ICU patients with available Clinical Frailty Scale assessment, country-level Human Development Index (HDI), and 30-day vital status. VIP1 and VIP2 enrolled patients aged ≥80 years, whereas COVIP enrolled patients aged ≥70 years. The primary exposure was exceptionally high human development, defined as HDI ≥ 0.90 versus '0.90. The primary outcome was 30-day mortality. Associations were assessed using logistic regression with robust standard errors clustered by country, adjusting for age, sex, SOFA score, frailty, admission diagnosis, organ support modalities, and treatment-limitation decisions. Exploratory mediation analyses examined selected ICU management variables as potential pathways linking HDI to mortality. Results Among 9920 patients included in the primary analysis, 8324 (83.9%) were treated in countries with HDI ≥ 0.90 and 1596 (16.1%) in countries with HDI ' 0.90. Thirty-day mortality was lower in high-HDI countries than in lower-HDI countries (40.0% vs. 53.3%). In unadjusted analysis, HDI ≥ 0.90 was associated with lower 30-day mortality (OR 0.58; 95% CI 0.38–0.90; P = 0.016). This association persisted after multivariable adjustment (adjusted OR 0.49; 95% CI 0.31–0.80; P = 0.004) and was similar after additional adjustment for study cohort (aOR 0.49; 95% CI 0.31–0.77; P = 0.002) and ICU bed capacity (aOR 0.50; 95% CI 0.29–0.86; P = 0.013). When modelled continuously, higher HDI was associated with lower mortality after full adjustment (OR 0.33 per 0.10-unit increase; 95% CI 0.19–0.56; P ' 0.001). Exploratory mediation analyses suggested that lower use of invasive mechanical ventilation in high-HDI countries may partially contribute to the observed association (NIE OR 0.86; 95% CI 0.83–0.89). Mediation analyses involving treatment-limitation decisions were more difficult to interpret because these decisions are closely linked to prognosis, clinical trajectory, and end-of-life practice. Conclusions In this large European cohort of older critically ill patients, treatment in countries with exceptionally high human development was associated with lower 30-day mortality. The association persisted after adjustment for patient-level severity, frailty, treatment limitation, organ support, study cohort, and ICU bed capacity. These findings suggest that country-level development and ICU management patterns, particularly invasive ventilation practices, may contribute to outcome differences. Because this was an observational secondary analysis using country-level exposure data, causal interpretation should remain cautious.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent461661
dc.identifier.doi10.1016/j.aicoj.2026.100101
dc.identifier.issn2110-5820
dc.identifier.otherPURE: 166995093
dc.identifier.otherPURE UUID: f7ab5254-0f72-4719-8b82-41beee262b76
dc.identifier.otherScopus: 105042673538
dc.identifier.urihttp://hdl.handle.net/10362/204478
dc.identifier.urlhttps://www.scopus.com/pages/publications/105042673538
dc.language.isoeng
dc.peerreviewedyes
dc.subjectElderly
dc.subjectFrailty
dc.subjectHDI
dc.subjectICU prognosis
dc.subjectVIP
dc.subjectCritical Care and Intensive Care Medicine
dc.subjectSDG 3 - Good Health and Well-being
dc.titleHuman Development Index and outcomes in older critically ill patientsen
dc.title.subtitleA European multicentre studyen
dc.typejournal article
degois.publication.titleAnnals of Intensive Care
degois.publication.volume16
dspace.entity.typePublication
rcaap.rightsopenAccess

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