Neighborhood Poverty and Pediatric Intensive Care Use

Abstract

BACKGROUND: Disparities in health service use have been described across a range of sociodemographic factors. Patterns of PICU use have not been thoroughly assessed. METHODS: This was a population-level, retrospective analysis of admissions to the Cincinnati Children's Hospital Medical Center PICU between 2011 and 2016. Residential addresses of patients were geocoded and spatially joined to census tracts. Pediatric patients were eligible for inclusion if they resided within Hamilton County, Ohio. PICU admission and bed-day rates were calculated by using numerators of admissions and bed days, respectively, over a denominator of tract child population. Relationships between tract-level PICU use and child poverty were assessed by using Spearman's r and analysis of variance. Analyses were event based; children admitted multiple times were counted as discrete admissions. RESULTS: There were 4071 included admissions involving 3129 unique children contributing a total of 12 297 PICU bed days. Child poverty was positively associated with PICU admission rates (r = 0.59; P , .001) and bed-day rates (r = 0.47; P , .001). When tracts were grouped into quintiles based on child poverty rates, the PICU bed-day rate ranged from 23.4 days per 1000 children in the lowest poverty quintile to 81.9 days in the highest poverty quintile (P , .001). CONCLUSIONS: The association between poverty and poor health outcomes includes pediatric intensive care use. This association exists for children who grow up in poverty and around poverty. Future efforts should characterize the interplay between patient-and neighborhoodlevel risk factors and explore neighborhood-level interventions to improve child health. WHAT'S KNOWN ON THIS SUBJECT: Poverty adversely affects health. The health impacts of socioeconomic status and poverty occur at the individual and community levels. Socioeconomic disparities in PICU use have not been as robustly assessed compared with other medical disciplines. WHAT THIS STUDY ADDS: Socioeconomic disparities extend to pediatric critical illness. Neighborhood poverty affects children' s need for intensive care. We argue that this association represents more than an aggregate of individual risk factors, and the interplay of individual and community demographics merits further investigation.

Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth

“…Poverty is associated with poor health outcomes and higher rates of pediatric ICU admissions in general. 35 Importantly, however, children of lower SES in our study were not more likely to have severe outcomes following hospitalization. The association between weight and severe respiratory COVID-19 is consistent with the adult literature; however, the mechanisms of this association require further study.…”

“…Poverty is associated with poor health outcomes and higher rates of pediatric ICU admissions in general. 35 Importantly, however, children of lower SES in our study were not more likely to have severe outcomes following hospitalization.…”

Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City

“… 27 This may reflect the unique sociodemographic factors of Bronx County, 16 particularly the high density of population/transmission and high rate of poverty, which has been associated with prolonged hospital stay and PICU admission. 28 …”

Children hospitalised with four common viral diseases showed epidemiological differences but few socio‐economic variations

“…The association between low socio-economic status and poor health outcomes in children is well described, even in high-income countries in Europe. [1][2][3] Demographic and socio-economic factors may also affect the risk for infectious diseases in children. 4 However, the pattern of how these factors affect infectious diseases is not as clear as the effect on overall health outcomes.…”