Related Experiment Video
Updated: May 3, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The effect of neighborhood and individual characteristics on pediatric critical illness
David Epstein1, Michael Reibel, Jennifer B Unger
1Department 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.
Insights
Children from minority racial/ethnic groups and those in low-income neighborhoods face higher severity of illness in the pediatric intensive care unit (PICU). These factors, including government insurance, are linked to worse outcomes, requiring further investigation.
Area of Science:
- Pediatric critical care medicine
- Health disparities research
- Socioeconomic determinants of health
Background:
- The impact of socioeconomic and racial/ethnic factors on pediatric intensive care unit (PICU) outcomes is not well understood.
- Existing research has not fully explored the interplay between individual-level characteristics and neighborhood context in pediatric critical illness.
Purpose of the Study:
- To investigate the association between individual racial/ethnic status and neighborhood characteristics (socioeconomic status, ethnic concentration) with pediatric critical illness severity.
- To determine if minority status and disadvantaged neighborhood factors adversely affect children's severity of illness upon PICU admission.
Main Methods:
- Retrospective analysis of clinical, geographic, and demographic data from 5,390 children admitted to a tertiary children's hospital PICU (2007-2011).
- Geographic information systems were used to link patient addresses to 2010 US Census tract data.
- Repeated measures models were employed to predict the Pediatric Index of Mortality 2 (PIM2) score and mortality, incorporating patient race/ethnicity, neighborhood demographics, and socioeconomic status.
Main Results:
- Latino children, particularly those in Latino ethnic enclaves, exhibited higher PIM2 scores compared to non-Latino children.
- Children with government insurance had significantly higher PIM2 scores than those with other insurance types.
- Lower median neighborhood income was inversely associated with PIM2 scores, indicating higher severity with lower income.
Conclusions:
- Lower median neighborhood income, Latino ethnicity, Latino children residing in predominantly Latino neighborhoods, and government insurance are associated with increased severity of illness at PICU admission.
- These findings highlight the influence of socioeconomic and racial/ethnic factors on pediatric critical care outcomes.
- Further research is needed to elucidate the mechanisms driving these disparities in critical illness severity.
Abstract:
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.
Related Concept Videos
01:18Factors Affecting Illness
For instance, risk factors are connected to illness,...
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:29Psychological and Sociocultural Causes of Schizophrenia