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Pediatrics. 2019 Dec;144(6). pii: e20190748. doi: 10.1542/peds.2019-0748. Epub 2019 Nov 1.

Neighborhood Poverty and Pediatric Intensive Care Use.

Andrist E1,2, Riley CL3,4, Brokamp C5,4, Taylor S6,4, Beck AF7,8,6,4.

Author information

1
Department of Critical Care Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan; andrist@med.umich.edu.
2
Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan.
3
Divisions of Critical Care Medicine.
4
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
5
Biostatistics and Epidemiology.
6
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
7
General and Community Pediatrics, and.
8
Hospital Medicine.

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 ρ 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 neighborhood-level risk factors and explore neighborhood-level interventions to improve child health.

PMID:
31676680
PMCID:
PMC6889973
[Available on 2020-12-01]
DOI:
10.1542/peds.2019-0748

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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