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The association between composite measures of social vulnerability and PICU admission for status asthmaticus
Justin Jones1, Margaret J Klein1, Alicia Adiwidjaja1,2
1Children's Hospital Los Angeles, Los Angeles, California, USA.
Insights
Socioeconomic factors like social vulnerability and child opportunity do not predict pediatric intensive care unit (PICU) admission for asthma. However, higher social vulnerability and lower child opportunity correlate with multiple asthma hospitalizations.
Area of Science:
- Pediatric critical care medicine
- Public health
- Health services research
Background:
- Limited understanding of socioeconomic factors influencing pediatric intensive care unit (PICU) admissions for asthma.
- Utilized Social Vulnerability Index (SVI) and Child Opportunity Index (COI) 2.0 to assess socioeconomic status.
- Hypothesized higher SVI and lower COI increase PICU admission risk for asthma.
Purpose of the Study:
- To investigate the association between socioeconomic factors (SVI, COI) and PICU admission for pediatric asthma.
- To compare socioeconomic profiles of asthma patients admitted to PICU versus general ward.
- To determine if socioeconomic vulnerability predicts PICU utilization for severe asthma.
Main Methods:
- Identified pediatric asthma admissions using ICD-10 codes.
- Geocoded patient addresses to census tract-level SVI and COI 2.0 data.
- Conducted univariate and regression analyses comparing SVI/COI with admission location (PICU vs. ward).
Main Results:
- No significant difference in SVI or COI between PICU and ward admissions for asthma.
- Asthma patients admitted to CHLA generally exhibited elevated SVI and low COI.
- Children with recurrent asthma hospitalizations showed higher SVI and lower COI.
Conclusions:
- While CHLA serves children with elevated socioeconomic risk (high SVI, low COI), these factors did not predict PICU admission for asthma.
- Socioeconomic vulnerability is associated with increased frequency of asthma hospitalizations, not necessarily PICU level of care.
- Further research needed to understand the nuances of socioeconomic impact on pediatric asthma outcomes.
Background:
Current knowledge of the impact of socioeconomic factors on the risk of admission to the pediatric intensive care unit (PICU) for asthma is limited. Using composite measures of social vulnerability-Social Vulnerability Index (SVI) and Child Opportunity Index (COI) 2.0-we compared patients admitted for status asthmaticus to the PICU and pediatric ward at Children's Hospital Los Angeles (CHLA). We hypothesized patients with a high SVI and low COI are at higher risk for PICU admission.
Methods:
Patients were identified using ICD-10 codes for asthma. Primary outcome was admission to PICU versus ward for status asthmaticus. Patient-registered residential street addresses were geocoded and spatially joined to SVI and COI 2.0 data at the census tract level. Univariate and regression analyses using the patient's SVI, COI 2.0, and admission location were conducted.
Results:
From January 2017 to March 2022, there were 2458 admissions matched to addresses from 1983 distinct patients. The overall median SVI for all patients was 0.86 (IQR 0.6, 0.9). Overall median COI was 25.0 (IQR 10, 50). There was no difference in SVI or COI for admission to the PICU versus the ward. However, children requiring multiple hospital admissions for asthma were associated with higher SVI and lower COI.
Conclusions:
Children admitted to CHLA for asthma had an elevated SVI and low COI. There was no difference between admission locations based on SVI or COI scores. This indicates we care for children at increased socioeconomic risk, but this did not increase PICU use for asthma.
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