Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States

Author:

McCrory Michael C.12,Akande Manzilat3,Slain Katherine N.4,Kennedy Curtis E.5,Winter Meredith C.67,Stottlemyre Morgan G.8,Wakeham Martin K.9,Barnack Kyle A.10,Huang Jia Xin1112,Sharma Meesha1112,Zurca Adrian D.13,Pinto Neethi P.14,Dziorny Adam C.15,Maddux Aline B.16,Garg Anjali17,Woodruff Alan G.12,Hartman Mary E.8,Timmons Otwell D.18,Heidersbach R. Scott11,Cisco Michael J.12,Sochet Anthony A.10,Wells Brian J.19,Halvorson Elizabeth E.2,Saha Amit K.1,

Affiliation:

1. Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC.

2. Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC.

3. Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK.

4. Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH.

5. Pediatrics, Baylor College of Medicine, Houston, TX.

6. Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

7. Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.

8. Pediatrics, Washington University School of Medicine, St. Louis, MO.

9. Pediatrics, Medical College of Wisconsin, Milwaukee, WI.

10. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children’s Hospital, St. Petersburg, FL.

11. Pediatrics, University of California San Francisco, UCSF Benioff Children’s Hospital Oakland, Oakland, CA.

12. Pediatrics, University of California San Francisco, UCSF Benioff Children’s Hospital San Francisco, San Francisco, CA.

13. Pediatrics, Northwestern University Feinberg School of Medicine and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

14. Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

15. Pediatrics, University of Rochester School of Medicine, Rochester, NY.

16. Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO.

17. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Charlotte Bloomberg Children’s Center, Baltimore, MD.

18. Pediatrics, Atrium Health Levine Children’s Hospital, Charlotte, NC.

19. Department of Biostatistics and Data Science; Wake Forest University School of Medicine, Winston-Salem, NC.

Abstract

Objectives: To evaluate for associations between a child’s neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS). Design: Retrospective cohort study. Setting: Fifteen PICUs in the United States. Patients: Children younger than 18 years admitted from 2019 to 2020, excluding those after cardiac procedures. Nationally-normed COI category (very low, low, moderate, high, very high) was determined for each admission by census tract, and clinical features were obtained from the Virtual Pediatric Systems LLC (Los Angeles, CA) data from each site. Interventions: None. Measurements and Main Results: Among 33,901 index PICU admissions during the time period, median patient age was 4.9 years and PICU mortality was 2.1%. There was a higher percentage of admissions from the very low COI category (27.3%) than other COI categories (17.2–19.5%, p < 0.0001). Patient admissions from the high and very high COI categories had a lower median Pediatric Index of Mortality 3 risk of mortality (0.70) than those from the very low, low, and moderate COI groups (0.71) (p < 0.001). PICU mortality was lowest in the very high (1.7%) and high (1.9%) COI groups and highest in the moderate group (2.5%), followed by very low (2.3%) and low (2.2%) (p = 0.001 across categories). Median PICU LOS was between 1.37 and 1.50 days in all COI categories. Multivariable regression revealed adjusted odds of PICU mortality of 1.30 (95% CI, 0.94–1.79; p = 0.11) for children from a very low versus very high COI neighborhood, with an odds ratio [OR] of 0.996 (95% CI, 0.993–1.00; p = 0.05) for mortality for COI as an ordinal value from 0 to 100. Children without insurance coverage had an OR for mortality of 3.58 (95% CI, 2.46–5.20; p < 0.0001) as compared with those with commercial insurance. Conclusions: Children admitted to a cohort of U.S. PICUs were often from very low COI neighborhoods. Children from very high COI neighborhoods had the lowest risk of mortality and observed mortality; however, odds of mortality were not statistically different by COI category in a multivariable model. Children without insurance coverage had significantly higher odds of PICU mortality regardless of neighborhood.

Funder

Wake Forest Department of Anesthesiology

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

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