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Child Opportunity Index and Outcomes of Children Admitted to US PICUs for Critical Asthma
Michael C McCrory1,2, Amit K Saha1, Colin M Rogerson3
1Departments of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Insights
Children with critical asthma admitted to pediatric intensive care units (PICUs) disproportionately came from low socioeconomic status neighborhoods. Lower socioeconomic status was linked to higher PICU readmission rates for asthma.
Area of Science:
- Pediatric critical care medicine
- Social determinants of health
- Asthma management
Background:
- Social drivers of health (SDOH) influence pediatric asthma severity.
- The association between SDOH and critical asthma outcomes in children is not well understood.
Purpose of the Study:
- To investigate the relationship between neighborhood socioeconomic status, using the Child Opportunity Index (COI), and outcomes for children with critical asthma admitted to pediatric intensive care units (PICUs).
Main Methods:
- A retrospective cohort study analyzed 2093 asthma admissions in 15 US PICUs (2019-2020) for children aged 2-17 years.
- Child Opportunity Index (COI) was assigned based on census tract data.
- Primary outcomes included use of positive pressure ventilation (PPV) and PICU mortality; secondary outcome was PICU readmission for asthma.
Main Results:
- Children admitted for asthma were disproportionately from very low COI neighborhoods (46.7%) compared to other respiratory (28.2%) or non-respiratory (24.8%) admissions.
- No significant association was found between COI category and PICU mortality or PPV use.
- PICU readmission for asthma showed a significant stepwise decrease with increasing COI category (p=0.02), with the highest rate in very low COI neighborhoods (8.9%).
Conclusions:
- Children with critical asthma admitted to PICUs are disproportionately from disadvantaged neighborhoods.
- While neighborhood opportunity did not impact mortality or ventilation needs, lower opportunity was significantly associated with increased risk of asthma-related PICU readmission.
Background:
Social drivers of health affect severity of asthma in children, but any association with outcomes in children with critical asthma is unknown.
Methods:
Retrospective cohort study of children 2-17 years old admitted to 15 United States PICUs for asthma from 2019 to 2020. Child Opportunity Index (COI) was assigned by census tract. Primary outcome was use of positive pressure ventilation (PPV), including invasive mechanical ventilation or non-invasive continuous or bilevel support.
Results:
A total of 2093 admissions in 1926 patients were included; median age was 6.9 years (IQR 4.3-10.8). Patients were often from very low COI neighborhoods (46.7%), a higher percentage than in children admitted to participating PICUs concurrently for other respiratory (28.2% very low COI) or non-respiratory causes (24.8%) (p < 0.0001 for each comparison). PICU mortality was low (0.57%), with no difference by COI category. Median PICU length of stay was within 8.5 h across COI categories (1.0-1.4 days). PPV was used in 39% of admissions. Multivariable analysis revealed no association of COI category with use of PPV; older age, commercial insurance, and origin of admission were associated with PPV use. PICU readmission for asthma during a subsequent hospitalization occurred in 7.1% patients during the study period, with a stepwise decrease as COI category increased [very low 8.9%; low 7.4%; moderate 5.0%; high 4.4%; very high 3.8%, p = 0.02].
Conclusions:
Children admitted to 15 PICUs for asthma were disproportionately from very low COI neighborhoods. Mortality and use of PPV were not significantly associated with COI; however, PICU readmission was significantly associated with lower COI.
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