Rurality and long-term outcomes after critical illness

Rationale: How rurality may influence recovery after critical illness is unknown. Objectives: To examine the association between rurality and disability, cognitive function, and health-related quality of life in intensive care unit survivors and whether it is modified by area-level socioeconomic deprivation. Methods: We measured rurality using Rural-Urban Commuting Area (RUCA) codes (range: 1 [most urban] to 10 [most rural]). At 3 and 12 months postdischarge, we assessed cognition, basic and instrumental activities of daily living, and quality of life. We measured area-level socioeconomic deprivation using the Area Deprivation Index (ADI). We used multivariable regression with inverse probability of attrition weighting, adjusting for prespecified covariates, including ADI. We conducted prespecified analyses assessing the interaction between rurality and ADI. Measurements and Main Results: We enrolled 1040 critically ill patients, with 781 surviving to hospital discharge. Survivors had a median (IQR) age of 62 (52-71) years and RUCA score of 4 (1–7). At a 3-month follow-up, greater rurality was associated with greater odds of disability in basic activities of daily living (adjusted odds ratio, 2.16; 95% CI, 1.27-3.67; P = .02). This association remained significant at the 12-month follow-up (P = .03). We found no association between rurality and other outcomes. There was no interaction between RUCA and ADI with basic activities of daily living, suggesting that socioeconomic deprivation did not alter these associations. Conclusions: Among survivors of critical illness, greater rurality was associated with greater disability in basic activities of daily living but not cognitive function or quality of life.