ArticleAnnals of intensive care2026
Human Development Index and outcomes in older critically ill patients: A European multicentre study.
Article in Annals of intensive care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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21 authors.
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Abstract
Background: 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; 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.
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