The effect of neighborhood and individual characteristics on pediatric critical illness.
The relationship between neighborhood/individual characteristics and pediatric intensive care unit (PICU) outcomes is largely unexplored. We hypothesized that individual-level racial/ethnic minority status and neighborhood-level low socioeconomic status and minority concentration would adversely affect children's severity of illness on admission to the PICU. Retrospective analyses (1/1/2007-5/23/2011) of clinical, geographic, and demographic data were conducted at an academic, tertiary children's hospital PICU. Clinical data included age, diagnosis, insurance, race/ethnicity, Pediatric Index of Mortality 2 score on presentation to the PICU (PIM2), and mortality. Residential addresses were geocoded and linked with 2010 US Census tract data using geographic information systems geocoding techniques. Repeated measures models to predict PIM2 and mortality were constructed using three successive models with theorized covariates including the patient's race/ethnicity, the predominant neighborhood racial/ethnic group, interactions between patient race/ethnicity and neighborhood race/ethnicity, neighborhood socioeconomic status, and insurance type. Of the 5,390 children, 57.8% were Latino and 70.1% possessed government insurance. Latino children (β = 0.31; p < 0.01), especially Latino children living in a Latino ethnic enclave (β = 1.13; p < 0.05), had higher PIM2 scores compared with non-Latinos. Children with government insurance (β = 0.29; p < 0.01) had higher PIM2 scores compared to children with other payment types and median neighborhood income was inversely associated with PIM2 scores (β = -0.04 per $10,000/year of income; p < 0.05). Lower median neighborhood income, Latino ethnicity, Latino children living in a predominantly Latino neighborhood, and children possessing government insurance were associated with a higher severity of illness on PICU admission. The reasons why these factors affect critical illness severity require further exploration.
Department of Anesthesiology Critical Care Medicine, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #3, Los Angeles, CA, 90027, USA, depstein@chla.usc.edu.
David
D
Epstein
Michael
M
Reibel
Jennifer B
JB
Unger
Myles
M
Cockburn
Loraine A
LA
Escobedo
David C
DC
Kale
Jennifer C
JC
Chang
Jeffrey I
JI
Gold
D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D062305:Geographic Mapping; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000208:ethnology; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000145:classification* / Q000191:economics; D015278:Intensive Care Units, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000145:classification*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012923:Social Class; D062606:Tertiary Care Centers / Q000706:statistics & numerical data