Pediatric ICU rates linked to housing quality, income, education

Key takeaways:

• Higher median income lowered the incidence of pediatric ICU admissions.
• ICU admission rates rose with increases in the percentages of vacant housing units and individuals who did not finish high school.

In assessing neighborhood-level socioeconomic position indicators, researchers found a link between pediatric ICU admission rates and housing quality, household income and education, according to results published in CHEST.

“Neighborhood-level inequities in transportation infrastructure, housing quality, education and financial disadvantage are a few key drivers related to disparities associated with increased incidence of [pediatric ICU (PICU)] admission,” Carlie N. Myers, MD, MS, attending physician of the PICU at Cincinnati Children’s Hospital and assistant professor of the department of pediatrics at University of Cincinnati, and colleagues wrote.

In an ecological study, Myers and colleagues assessed 2,476 PICU patients (median age, 4.3 years; 57.9% boys; 57% Black) living in the city of Baltimore or Baltimore County and admitted between January 2016 and December 2019, to find out if neighborhood-level disadvantage indicators are linked to PICU admission through regression analysis.

Researchers used area deprivation index (ADI), which combines 17 data points from the U.S. census related to income, education, employment and housing, to find neighborhood-level advantage in the two cohorts. The scoring scale ranges from 1 to 100, with higher scores signaling residence in deprived/disadvantaged neighborhoods.

Baseline characteristics

Of the total cohort, 1,351 patients (72.6% Black; 14% white; 1% Asian) resided in the city of Baltimore. The median ADI of this group was 75, and 68% lived in more disadvantaged areas, as indicated by an ADI score greater than 60.

The rest of the total cohort (n = 1,125; 38.2% Black; 42% white; 4.9% Asian) resided in Baltimore County. This group had a median ADI of 39, with a high proportion of patients living in areas with an ADI less than 60 (82.3%).

Between the city of Baltimore cohort and the Baltimore County cohort, two clinical variables significantly differed: median PICU stay (1.4 days vs. 1.6 days; P < .001) and mortality (23 patients [1.7%] vs. 35 patients [3.1%]; P < .021).

Neighborhood-level socioeconomic position indicators

During regression analysis, researchers noted a link between the percentage of families living below the poverty line and more PICU admissions in both cohorts (city, IRR = 1.09 per 10% increase; 95% CI, 1-1.18; county, IRR = 1.19 per 10% increase; 95% CI, 1.05-1.36).

Further, the rate of PICU admissions was elevated in areas made up of more vacant housing units in both regions of Baltimore (city, IRR = 1.1 per 10% increase; 95% CI 1.01-1.21; county, IRR = 1.46 per 10% increase; 95% CI, 1.21-1.77).

In Baltimore County, researchers noted that as the percentage of occupied homes that did not have vehicles in a neighborhood went up, so did the PICU admission rate (IRR = 1.23 per 10% increase; 95% CI, 1.11-1.37). This was also the case in the city of Baltimore (IRR = 1.14 per 10% increase; 95% CI, 1.07-1.21).

Education was another neighborhood-level socioeconomic indicator that significantly impacted PICU admissions. A 10% increase in the percentage of individuals without a high school diploma aged older than 18 years meant a 16% higher PICU admission rate in the city of Baltimore (IRR = 1.16; 95% CI, 1.04-1.3) and a 37% higher rate in Baltimore County (IRR = 1.37; 95% CI, 1.22-1.54), according to researchers.

Notably, the link between an increased percentage of unemployed individuals and a higher PICU admission rate was only significant in the Baltimore County cohort (IRR = 1.49; 95% CI, 1.25-1.79). Researchers also found a significantly higher rate of PICU admissions in areas made up of more housing units built before 2010 in this cohort (IRR = 2.03 per 10% increase; 95% CI, 1.34-3.08).

Lastly, in both cohorts, researchers found a 9% reduction in PICU admissions per $10,000 rise in median household income (city, IRR = 0.91; 95% CI, 0.86-0.95; county, IRR = 0.91; 95% CI, 0.88-0.94).

“As health care reform focuses on minimizing cost and optimizing value and equity, knowledge of the relationships between PICU resource use and socioeconomic disparities becomes relevant,” Myers and colleagues wrote. “Exploring disparities within the PICU based on neighborhood-level markers of deprivation can guide sociopolitical policy for the advancement of child health.”