Association of community-level social vulnerability with US acute care hospital intensive care unit capacity during COVID-19

The COVID-19 pandemic has placed unprecedented stress on US acute care hospitals, leading to overburdened ICUs. It remains unknown if increased COVID-19 ICU occupancy is crowding out non-COVID-related care and whether hospitals in vulnerable communities may be more susceptible to ICUs reaching capacity. Using facility-level hospitalization data, we conducted a retrospective observational cohort study of 1753 US acute care hospitals reporting to the US Department of Health and Human Services Protect database from September 4, 2020 to February 25, 2021. 63% of hospitals reached critical ICU capacity for at least two weeks during the study period, and the surge of COVID-19 cases appeared to be crowding out non-COVID-19-related intensive care needs. Hospitals in the South (OR = 3.31, 95% CI OR 2.31–4.78) and West (OR = 2.28, 95% CI OR 1.51–3.46) were more likely to reach critical capacity than those in the Northeast, and hospitals in areas with the highest social vulnerability were more than twice as likely to reach capacity as those in the least vulnerable areas (OR = 2.15, 95% CI OR 1.41–3.29). The association between social vulnerability and critical ICU capacity highlights underlying structural inequities in health care access and provides an opportunity for policymakers to take action to prevent strained ICU capacity from compounding COVID-19 inequities.