Impact of geographical location on ICU outcomes in adults: a scoping review.

Authors

Jacob Zand, Nattaya Raykateeraroj, Je Min Suh, Carl Reyneke, Anoop N Koshy, Benjamin Cailes, Dong-Kyu Lee, Laurence Weinberg

Published in

BMJ open. Volume 16. Issue 7. Pages e114956. Jul 09, 2026. Epub Jul 09, 2026.

Abstract

Rural populations experience poorer health outcomes than urban counterparts globally. Limited studies have examined the impact of geographical location-specifically travel distance/time and rurality-on intensive care unit (ICU) outcomes. This scoping review aimed to map literature on geographical location and ICU outcomes to better inform policy and improve ICU access in underserved communities.
Scoping review.
MEDLINE, CINAHL and Embase were searched through to 8 May 2025. Grey literature was identified through ProQuest Dissertations and Theses Global, including dissertations, theses and conference proceedings.
Studies examining the impact of geographical location (rurality and/or travel distance/time) on ICU outcomes in adult populations were included. No restrictions were placed on country, healthcare setting or date of publication. Peer-reviewed primary studies and grey literature were eligible; editorials, commentaries and reviews were excluded.
Two reviewers independently extracted study characteristics, rurality definitions, travel distance/time measures and ICU outcomes using a standardised form and synthesised descriptively.
23 articles and 1 conference abstract; all were retrospective studies. 23 studies reported on rurality with 20 specifying the definition used. Six studies reported travel distance/time, all detailing measurement methods. 12 studies mentioned baseline patient comorbidities, 18 reported ICU admissions and 4 hospital/ICU readmissions. More studies reported longer ICU length of stay and greater ICU intervention use among rural compared with urban/metropolitan patients, although mortality findings were inconsistent. Heterogeneity limited direct comparison. No clear association was found between travel distance/time and ICU outcomes.
Inconsistent rurality definitions complicated comparisons. The mapped literature reported longer ICU LOS and greater intervention use for rural compared with urban/metropolitan patients; however, mortality findings were inconsistent with no predictive pattern. No clear association was observed between travel distance/time and ICU outcomes. Future research should adopt standardised rurality definitions, account for preadmission health status and focus on condition specific contexts to inform policy.

PMID:
42425556
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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