With recent prioritization of equity in pediatric health outcomes, there has been a shift to examine neighborhood-level healthcare disparities within pediatric populations, specifically in the context of critical illness.
Is there an association between individual indicators of neighborhood-level disadvantage and incidence of pediatric intensive care unit (PICU) admission?
An ecological study, at the census tract-level, of pediatric patients admitted to a PICU in a large urban tertiary pediatric hospital.
Pediatric patients ages <18 years admitted to the PICU from January 1, 2016, to December 31, 2019, with a residential address in Baltimore City or Baltimore County on the day of admission were included in the study. Demographic and clinical characteristics of children admitted to the PICU were summarized, with primary outcome being PICU admission. Unadjusted negative binomial regression was used to examine the association between CT-level PICU admissions and the previously described CT-level indicators of neighborhood SEP. Regression models included an offset term for the population < 18 years of age for each CT; results of models are reported as incidence rate ratios (IRR) with corresponding 95% confidence intervals (CI).
We identified 2476 PICU admissions: 1351 patients from Baltimore City (10.25 per 1000 children) and 1125 patients from Baltimore County (6.31 per 1000 children). The majority of PICU admissions (n = 906, 68%) for Baltimore City represented an Area Deprivation Index (ADI) > 60, while the majority of Baltimore County PICU admissions (n = 919, 82.3%) represented an ADI < 60. At the neighborhood level, percentage of families living below the poverty line was associated with greater incidence of PICU admission in Baltimore City (IRR = 1.09; 95%CI: 1.00, 1.18) and Baltimore County (IRR = 1.19; 95% CI: 1.05, 1.36). For every $10,000 increase in median household income, PICU admission rates dropped by 9% for Baltimore City (IRR = 0.91; 95%CI: 0.86, 0.95) and Baltimore County (IRR = 0.91; 95%CI: 0.88, 0.94). Neighborhoods with vacant housing units were also associated with a higher incidence of PICU admission in Baltimore City (IRR = 1.10; 95%CI: 1.01, 1.21) and County (IRR = 1.46; 95%CI: 1.21, 1.77), as was a 10% increase in occupied homes without vehicles (Baltimore City IRR = 1.14; 95%CI: 1.07, 1.21; County IRR = 1.23; 95%CI: 1.11, 1.37).
Health outcomes of pediatric critical illness should be examined in the context of structural determinants of health, including neighborhood-level and environmental characteristics.

Copyright © 2023. Published by Elsevier Inc.