Intersectional Influences on Non-Engagement Among Critical Care Survivors: A Prospective Cohort Study

Background Critical care survivors face long-term health and social care needs. Barriers to engagement with essential follow-up services contribute to worse outcomes. Understanding these barriers is crucial for equitable healthcare provision and service design. Methods We conducted a prospective cohort study of adult patients admitted to a critical care unit, between April 2023 and December 2024. Eligible patients with valid contact details were sent a questionnaire electronically, designed to identify needs, 72 hours post critical care discharge. The primary outcome was service engagement, defined as completion of the electronic questionnaire. Demographic and clinical data were obtained from the local audit team. Primary exposures were index of multiple deprivation (IMD) and ethnicity. Associations were determined with multivariable logistic regression (adjusted odds ratios, aOR) and intersectional analysis. Results Of 3058 patients discharged, 2191 (72%) were eligible for analysis. The majority (1558/2191,71%) did not engage with the follow-up service. Higher non-engagement was observed in patients from more deprived areas (IMD Quintiles 1[aOR = 1.39, CI = 1.03–1.88] and 2 [aOR = 1.46, CI = 1.08–1.98]) and of Black ethnic background (aOR = 1.69, CI = 1.25–2.28). Intersectional analysis revealed further at-risk populations (915/2191, 42%), including a large group of White individuals in areas of high deprivation and a small group of Black individuals in the least deprived areas. Conclusions Intersectional analysis identified groups at-risk of non-engagement overlooked by single-factor approaches. Considering both population size and relative risk is vital for designing critical care follow-up support services to maximise impact, allocate resources efficiently, and reduce existing disparities in recovery outcomes for critical care survivors.