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Published on: August 7, 2017
Income-driven socioeconomic status and presenting illness severity in children with acute respiratory failure
Alicia G Kachmar1, David Wypij2,3,4, Mallory A Perry5
1Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Socioeconomic status (SES) did not correlate with illness severity in critically ill children admitted to the pediatric intensive care unit (PICU). Further research is needed to understand how SES impacts critical illness in children.
Area of Science:
- Pediatric critical care medicine
- Public health
- Health disparities
Background:
- Children in low socioeconomic status (SES) communities face higher risks for poor health outcomes, particularly when critically ill.
- Understanding the link between SES and illness severity in pediatric intensive care unit (PICU) admissions is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between socioeconomic status (SES) and illness severity in children admitted to the PICU with acute respiratory failure.
- To analyze how income-based SES metrics relate to clinical outcomes in critically ill pediatric patients.
Main Methods:
- Secondary analysis of a multicenter clinical trial involving 2006 children (2 weeks to 17 years) requiring mechanical ventilation for acute respiratory failure.
- Patients were categorized into income quartiles based on census tract median income; demographic, clinical, and outcome data were analyzed.
- Illness severity was assessed using Pediatric Risk of Mortality (PRISM) scores and pediatric acute respiratory distress syndrome (PARDS) criteria.
Main Results:
- Children in the lowest income quartile were more likely to be Black, younger, and hospitalized for asthma or bronchiolitis.
- Children in the highest income quartile were more likely to be older, non-Hispanic White, and hospitalized for pneumonia.
- After controlling for covariates, no significant association was found between income quartile and illness severity (PRISM scores or PARDS).
Conclusions:
- Income-based socioeconomic status, as measured in this study, was not associated with illness severity upon PICU admission for children with acute respiratory failure.
- The findings suggest that current income-based SES measures may not fully capture the complex relationship between socioeconomic factors and pediatric critical illness severity.
- Further research employing more robust SES measurement tools is recommended to elucidate the mechanisms linking socioeconomic factors to critical illness outcomes in children.
Abstract:
Children living in low socioeconomic communities are vulnerable to poor health outcomes, especially when critically ill. The purpose of this study was to investigate the association between socioeconomic status (SES) and illness severity upon pediatric intensive care unit (PICU) admission in children with acute respiratory failure. This secondary analysis of the multicenter Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial includes children, 2 weeks to 17 years old, mechanically ventilated for acute respiratory failure; specifically, subjects who had parental consent for follow-up and residential addresses that could be matched with census tracts (n = 2006). Subjects were categorized into quartiles based on income, with a median income of $54,036 for the census tracts represented in the sample. Subjects in the highest income quartile were more likely to be older, non-Hispanic White, and hospitalized for pneumonia. Subjects in the lowest income quartile were more likely to be Black, younger, and hospitalized for asthma or bronchiolitis, to have age-appropriate baseline functional status, and history of prematurity and asthma. After controlling for age group, gender, race, and primary diagnosis, there were no associations between income quartile and either Pediatric Risk of Mortality scores or pediatric acute respiratory distress syndrome. As measured, income-based SES was not associated with illness severity upon PICU admission in this cohort of patients. More robust and reliable methods for measuring SES may help to better explain the mechanisms by which socioeconomic affect critical illness.
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