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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dc.contributor.authorMartin-Loeches, Ignacio
dc.contributor.authorSprung, Charles L.
dc.contributor.authorWolsztynski, Eric
dc.contributor.authorCusack, Rachael
dc.contributor.authorLobo, Suzana Margareth
dc.contributor.authorProtti, Alessandro
dc.contributor.authorAvidan, Alexander
dc.contributor.funderScience Foundation Ireland (SFI), SFI, 12/RC/2289-P2
dc.date.accessioned2026-02-11T15:50:02Z
dc.date.available2026-02-11T15:50:02Z
dc.date.issued2025-12
dc.description.abstractAim: 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.en
dc.description.sponsorshipThis research was partly supported by Science Foundation Ireland (Grant number 12/RC/2289-P2), co-funded under the European Regional Development Fund. This was the only specific funding received for this study.
dc.description.versionPublished Version
dc.format.extent10
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid29
dc.identifier.authororcidMartin-Loeches, Ignacio
dc.identifier.authororcidSprung, Charles L.
dc.identifier.authororcidWolsztynski, Eric§0000-0001-9770-9769
dc.identifier.authororcidCusack, Rachael
dc.identifier.authororcidLobo, Suzana Margareth
dc.identifier.authororcidProtti, Alessandro
dc.identifier.authororcidAvidan, Alexander
dc.identifier.citationMartin-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
dc.identifier.doi10.1186/s13613-025-01419-1
dc.identifier.endpage10
dc.identifier.issn2110-5820
dc.identifier.issued1
dc.identifier.journaltitleAnnals of Intensive Care
dc.identifier.otherORCID: /0000-0001-9770-9769/work/205467180
dc.identifier.startpage1
dc.identifier.urihttps://hdl.handle.net/10468/18517
dc.identifier.volume15
dc.language.isoen
dc.publisherSociete de Reanimation de Langue Francaise
dc.relation.urihttps://www.scopus.com/pages/publications/86000352861
dc.relation.urihttps://ucc.elsevierpure.com/en/publications/df2c9725-f234-4bcf-bbc1-3542356e1341
dc.rights© 2025, the Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/
dc.rights.accessrightsopen access
dc.rights.licensenameAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.statusPeer reviewed
dc.subjectEnd-of-life
dc.subjectGross national income
dc.subjectHospital mortality
dc.subjectIntensive care
dc.subjectLife-sustaining measures
dc.subject[Maths]
dc.subject[Insight]
dc.titleEnd-of-life decision disparities according to the gross national income in critically ill patients: a secondary analysis of the ETHICUS-2 studyen
dc.typeArticle (peer-reviewed)
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