Intersectionality and mortality in intensive care units

Authors

DOI:

https://doi.org/10.26694/reufpi.v15i1.7102

Keywords:

Intersectional Framework, Intensive Care Units, Mortality, Racism

Abstract

Objective: To analyze the effect exerted by the intersectionality between gender and race/skin color on mortality among patients admitted to an Intensive Care Unit. Methods: A retrospective cohort study conducted with patients admitted to an ICU for adults from April 1st, 2022, to April 30th, 2024. Results: The study population was comprised by 4,878 patients, mostly subjected to orotracheal intubation. From this total, 30.5% evolved to death, with higher prevalence among non-white men. The reasons for hospitalization varied according to gender and race/skin color: injuries and poisoning were more common among white women and non-white men; in turn, non-white women and white men were mostly admitted due to diseases of the circulatory system. In relation to outcomes, white and non-white men presented higher risk of death when compared to white women. Conclusion: The current study evidenced significant disparities in terms of clinical outcomes in non-white patients admitted to an Intensive Care Unit. Such results reflect inequalities in access to and quality of the health care provided to this population segment.

Author Biographies

Maria Eduarda Cardoso Silva, Universidade Estadual de Londrina

Nurse enrolled in the Postgraduate Program of Residency in Adult Intensive Care at the State University of Londrina

Denise Andrade Pereira, State University of Londrina

Nursing Professor in the Postgraduate Program in Adult Intensive Care Residency.

Professor at the State University of Londrina in the area of ​​Medical-Surgical Nursing and Communicable Diseases.

Renne Rodrigues, Federal University of the Southern Border

Professor of the Epidemiology Center of the Medical School at the Federal University of the Southern Frontier.

Professor of the Graduate Program in Public Health at the State University of Londrina

References

1. Siira E, Linden K, Wallström S, Björkman I. Intersectionality in nursing research: A systematic review. Nursing open [Internet]. 2023;10(12):7509-27.https://doi.org/10.1002/nop2.2021

2. Bowleg L. Evolving intersectionality within public health: from analysis to action. AJPH [Internet]. 2021;111(1):88-90. https://doi.org/10.2105/AJPH.2020.306031

3. Nascimento BA, Lima DM, Passos SG. Humanização da assistência de enfermagem na unidade de terapia intensiva. Revista JRG de Estudos Acadêmicos. 2023;6(13):2024-32.

4. Corrêa GP, Rabito LBF, Ciccheto JRM, Salci MA, Oliveira Moura DR, Sanches RdCN. Perfil clínico-epidemiológico de pacientes internados em unidade de terapia intensiva de um hospital escola. Enfermería Global. 2024;23(2):495-533.

5. Sungono V, Hariyanto H, Soesilo TEB, Adisasmita AC, Syarif S, Lukito AA, et al. Cohort study of the APACHE II score and mortality for different types of intensive care unit patients. Postgraduate medical journal. 2022;98(1166):914-8.

6. Oh T-K, Kim H-G, Song I-A. Epidemiologic study of intensive care unit admission in South Korea: a nationwide population-based cohort study from 2010 to 2019. International journal of environmental research and public health. 2022;20(1):81.

7. Associação de Medicina Intensiva Brasileira (AMIB). UTIs não são o fim da linha para pacientes críticos [Internet]. 2024 [citado 2024 set 5]. Available from:https://amib.org.br/category/noticias/utis-brasileiras/

8. Cardoso FS, Gomes DCK, Silva ASd. Racial inequality in health care of adults hospitalized with COVID-19. Cadernos de Saúde Pública. 2023;39:e00215222.

9. Santos GSR, Paulino GB, Rocha FM, Luz RS, Santos GVR, Dumas GB, et al. Política pública, saúde e racismo: revisão integrativa da literatura. Práticas e Cuidado: Revista de Saúde Coletiva. 2022;3:e14537-e.

10. Santos PSA, Mateus SRM, Oliveira Silva MF, Souza Figueiredo PT, Campolino RG. Perfil epidemiológico da mortalidade de pacientes internados por Covid-19 na unidade de terapia intensiva de um hospital universitário. Brazilian Journal of Development. 2021;7(5):45981-92.

11. Almeida NHF, Silva Matos R, Santos Morais L, Lima Silva JMF, Pinheiro WR, Souza ASR. Perfil sociodemográfico e clínico de pacientes com COVID-19 que foram a óbito em Unidade de Terapia Intensiva. Revista Eletrônica Acervo Saúde. 2024;24(6):e16385-e.

12. Lima LR, Severina IC, Moreira VR, Stival MM. Perfil epidemiológico e de morbimortalidade da unidade de terapia intensiva de um hospital público. REVISA. 2021;10(2):446-58.

13. Riviello ED, Dechen T, O’Donoghue AL, Cocchi MN, Hayes MM, Molina RL, et al. Assessment of a crisis standards of care scoring system for resource prioritization and estimated excess mortality by race, ethnicity, and socially vulnerable area during a regional surge in COVID-19. JAMA network open. 2022;5(3):e221744-e.

14. Lopes GM, Paixão Duarte TT, Silva KGN, Silva Magro MC. Gravidade e mortalidade de pacientes críticos em ventilação mecânica. Research, Society and Development. 2022;11(12):e548111234761-e.

15. Silva Júnior CD, Souza JR, Silva NS, Almeida SP, Torres LM. Saúde do homem na atenção básica: fatores que influenciam a busca pelo atendimento. Revista Ciência Plural. 2022;8(2):1-18.

16. Silva JO, Nodari PRG, Alencar BT, Silva RB, Aleixo MLM. Desafios da implementação da Política Nacional de Atenção Integral a Saúde do Homem em Mato Grosso. Research, Society and Development. 2022;11(2):e5311225354-e.

17. Miró Ò, Alquézar-Arbé A, Llorens P, Martín-Sánchez F, Jiménez S, Martín A, et al. Comparison of the demographic characteristics and comorbidities of patients with COVID-19 who died in Spanish hospitals based on whether they were or were not admitted to an intensive care unit. Medicina Intensiva (English Edition). 2021;45(1):14-26.

18. Dantas MNP, Silva MdFdS, Barbosa IR. Reflexões sobre a mortalidade da população negra por covid-19 e a desigualdade racial no Brasil. Saúde e Sociedade. 2022;31:e200667pt.

19. Anunciação D, Pereira LL, Silva HP, Nunes APN, Soares JO. (Des) caminhos na garantia da saúde da população negra e no enfrentamento ao racismo no Brasil. Ciência & Saúde Coletiva. 2022;27:3861-70.

20. Oliveira LGF, Magalhães M. Percurso da implantação da política nacional de saúde integral da população negra no Brasil. Revista brasileira de estudos de população. 2022;39:e0214.

21. Cândido NMdO, Detoni PP, Ginar-Silva S. Percepção de racismo em ambientes de saúde e fatores associados em mulheres negras. Saúde em Debate. 2024;48:e8692.

22. Goes EF, Nascimento ERd. Mulheres negras e brancas e os níveis de acesso aos serviços preventivos de saúde: uma análise sobre as desigualdades. Saúde em Debate. 2013;37:571-9.

23. Silva MT, Teixeira LB, Santos DCR, Santos Filho LEP, Correa PDS. Acesso a saúde tem cor e não é preta: revisão integrativa do racismo institucional à população negra. RECIMA21-Revista Científica Multidisciplinar-ISSN 2675-6218. 2021;2(10):e210871-e.

24. Jäntti S, Ponkilainen V, Kuitunen I, Uimonen MM, Huttunen T, Mattila VM. Intensive care unit admissions with and without COVID-19 in Finland from 2017 to 2021: a retrospective register-based study. BMC anesthesiology. 2023;23(1):251.

25. Kyalwazi AN, Loccoh EC, Brewer LC, Ofili EO, Xu J, Song Y, et al. Disparities in cardiovascular mortality between Black and White adults in the United States, 1999 to 2019. Circulation. 2022;146(3):211-28.

26. Modra LJ, Higgins AM, Pilcher DV, Bailey MJ, Bellomo R. Sex differences in mortality of ICU patients according to diagnosis-related sex balance. American journal of respiratory and critical care medicine. 2022;206(11):1353-60.

27. Agenda Mais SUS. Relatório Técnico nº 2/2023: Saúde da População Negra [Internet]. 2023 [citado 2025 mar 15]. Available from:https://agendamaissus.org.br/wp-content/uploads/2023/06/ieps-boletim02-saude-populacao-negra.pdf

28. O’Halloran AC, Holstein R, Cummings C, Kirley PD, Alden NB, Yousey-Hindes K, et al. Rates of influenza-associated hospitalization, intensive care unit admission, and in-hospital death by race and ethnicity in the United States from 2009 to 2019. JAMA Network Open. 2021;4(8):e2121880-e.

29. Himmelstein G, Ceasar JN, Himmelstein KE. Hospitals that serve many Black patients have lower revenues and profits: structural racism in hospital financing. Journal of General Internal Medicine. 2023;38(3):586-91.

30. Reis SS, Bortoloto CC. Racismo estrutural nas Política de Saúde: impressões de usuários negros. Revista Serviço Social em Revista Vol. 2024;27(3):806-31.

31. Ministério da Saúde (BR). HumanizaSUS: Política Nacional de Humanização [Internet]. Brasília: Ministério da Saúde; 2013 [citado 2025 mar 31]. Available from:http://bvsms.saude.gov.br/bvs/publicacoes/humanizasus_politica_nacional_humanizacao.pdf

Downloads

Published

2026-11-09

How to Cite

1.
Silva MEC, Pereira DA, Rodrigues R. Intersectionality and mortality in intensive care units. Rev Enferm UFPI [Internet]. 2026 Nov. 9 [cited 2026 Nov. 10];15(1). Available from: https://www.periodicos.ufpi.br/index.php/reufpi/article/view/7102

Issue

Vol. 15 No. 1 (2026): Rev Enferm UFPI

Section

Original

License

Copyright (c) 2026 Rev Enferm UFPI

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Autores mantém os direitos autorais e concedem à REUFPI o direito de primeira publicação, com o trabalho licenciado sob a Licença Creative Commons Attibution BY  4.0 que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.