Evidence map›Paper›PMID 42100010›Full record

ArticleThe Lancet regional health. Western Pacific2026

Critical care access and outcomes in residents of inpatient-care catchment areas with and without ICUs: a nationwide cohort study in Japan.

Hiroyuki Ohbe, Nobuaki Shime, Kei Nishiyama, Takuya Sato, Kent Doi, Kiyohide Fushimi, Hiroki Matsui, Hideo Yasunaga, Daisuke Kudo

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet regional health. Western Pacific, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Hiroyuki OhbeDepartment of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Nobuaki ShimeDepartment of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8551, Japan.
Kei NishiyamaDepartment of Emergency and Critical Care, Niigata University, 1-754 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan.
Takuya SatoDepartment of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan.
Kent DoiDepartment of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan.
Kiyohide FushimiDepartment of Health Policy and Informatics, Institute of Science Tokyo Graduate School, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8550, Japan.
Hiroki MatsuiDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Hideo YasunagaDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Daisuke KudoDepartment of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: In Japan, many secondary medical areas (SMAs), defined as regional self-sufficient inpatient-care planning units, are not equipped with intensive care unit (ICU) beds. We aimed to describe the national distribution of SMAs without ICUs, compared post-arrival outcomes among ICU-admitted patients, and evaluated ICU access and mortality among critically ill patients. Methods: This retrospective cohort study linked data from the Diagnosis Procedure Combination database with the Hospital Bed Function Report of 2022. The primary exposure was residence in an SMA without ICU beds. Outcomes were assessed using multivariate generalized linear models. Findings: Among 335 SMAs, 140 (41.8%) lacked ICU beds, encompassing 11.6% of the national population and 46.0% of the land area. Among the 282,894 ICU-admitted patients, residents of SMAs without ICUs travelled substantially farther to reach an ICU (median 32.4 vs. 5.7 km), but had no statistically significant difference in adjusted in-hospital mortality (adjusted risk difference, -0.38 percentage points; 95% confidence interval [CI], -0.81 to 0.05). In a separate analysis of 467,200 critically ill patients, those living in SMAs without ICUs had lower ICU admission rates (24.9% vs. 35.6%) and statistically significant but small increase in adjusted in-hospital mortality (adjusted risk difference +0.96 percentage points; 95% CI: 0.17-1.75). Interpretation: Nearly half of SMAs lack ICU beds. While post-arrival ICU outcomes were similar, residence in an SMA without ICUs was associated with reduced ICU access and higher mortality among critically ill patients. Funding: Ministry of Health, Labor and Welfare, Japan; and Japan Agency for Medical Research and Development.

Indexed as

Healthcare disparitiesHealth services accessibilityIntensive care unitsJapanSecondary medical areas

Identifiers

PMID42100010
PMCPMC13146584

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.