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RATIONALE Patients who identify as from racial or ethnic minority groups who have sepsis or acute respiratory failure (ARF) experience worse outcomes relative to nonminority patients, but processes of care accounting for disparities are not well-characterized. OBJECTIVE Determine whether reductions in intensive care unit (ICU) admission during hospital-wide capacity strain occur preferentially among patients who identify from racial or ethnic minority groups. METHODS This retrospective cohort among 27 hospitals across the Philadelphia metropolitan area and northern California between 2013-2018 included adult patients with sepsis and/or ARF who did not require life support at the time of hospital admission. An updated model of hospital-wide capacity strain was developed that permitted determining relationships between patient race, ethnicity, ICU admission, and strain. RESULTS After adjustment for demographics, disease severity, and study hospital, patients who identified as Asian or Pacific Islander had the highest adjusted ICU admission odds relative to patients who identified as White in both the sepsis and ARF populations (OR 1.09, p=0.006 and 1.26, p<0.001). ICU admission was also elevated for patients with ARF who identified as Hispanic (OR 1.11, p=0.020). Capacity strain did not modify differences in ICU admission for patients who identified with a minority group in either disease population (all interactions p> 0.05). CONCLUSIONS Systematic differences in ICU admission patterns were observed for patients that identified as Asian, Pacific Islander, and Hispanic. However, ICU admission was not restricted from these groups and capacity strain did not preferentially reduce ICU admission from patients identifying from minority groups. Further characterization of provider decision making can help contextualize these findings as the result of disparate decision making or a mechanism of equitable care.