End-of-life decision disparities according to the gross national income in critically ill patients: a secondary analysis of the ETHICUS-2 study
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Published Version
Date
2025-12
Authors
Martin-Loeches, Ignacio
Sprung, Charles L.
Wolsztynski, Eric
Cusack, Rachael
Lobo, Suzana Margareth
Protti, Alessandro
Avidan, Alexander
Journal Title
Journal ISSN
Volume Title
Publisher
Societe de Reanimation de Langue Francaise
Published Version
Abstract
Aim: This study aimed to evaluate the association of end-of-life decisions and time to death in a global cohort of critically ill patients who participated in the international study on end-of-life practices in intensive care units (ICU) (Ethicus-2 study). Methods: A post hoc analysis was conducted on data from a worldwide observational study that prospectively recruited adult ICU patients who died between September 1, 2015, and September 30, 2016, from 199 ICUs in 36 countries. Results: The end-of-life pathways of 10,547 ICU non-survivors were s analysed. Patients in high-income countries exhibited a significantly shorter time to death compared to those from middle-income countries. Additionally, therapeutic decisions were found to have a significant but varied association with the length of ICU stay across gross national income (GNI) groups. Specifically, patients in high-income countries with no decision had the shortest length of stay (LOS) overall. However, withdrawing or withholding life-sustaining treatment led to longer LOS in both middle and high GNI countries. Conclusion: This study’s findings highlight the need for uniformity in global end-of-life decision-making. Outcomes are significantly associated with gross national income (GNI). Moreover, patients in high-income nations tend to have shorter ICU stays before death.
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Keywords
End-of-life , Gross national income , Hospital mortality , Intensive care , Life-sustaining measures , [Maths] , [Insight]
Citation
Martin-Loeches, I, Sprung, C L, Wolsztynski, E, Cusack, R, Lobo, S M, Protti, A & Avidan, A 2025, 'End-of-life decision disparities according to the gross national income in critically ill patients : a secondary analysis of the ETHICUS-2 study', Annals of Intensive Care, vol. 15, no. 1, 29, pp. 1-10. https://doi.org/10.1186/s13613-025-01419-1