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Social Determinants of Health and Delirium in the PICU: Secondary Analysis of a 2014-2015 Observational Dataset
Kate Madden1, Caroline Andy2, Evan T Sholle2,3
1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.
Insights
Geospatial determinants of health, like the Child Opportunity Index (COI), are linked to pediatric intensive care unit (PICU) delirium. Lower COI was associated with higher delirium rates in children, suggesting a need for further investigation.
Area of Science:
- Pediatric critical care medicine
- Public health
- Health equity
Background:
- Delirium is a common complication in pediatric intensive care units (PICUs).
- Geospatial factors may influence health outcomes, but their association with pediatric delirium is understudied.
Purpose of the Study:
- To investigate the relationship between geospatial determinants of health and the prevalence of delirium in the pediatric intensive care unit.
- To explore if the Child Opportunity Index (COI) is associated with pediatric delirium.
Main Methods:
- Secondary analysis of an observational study dataset from an urban academic tertiary care PICU.
- Included all children admitted over a 12-month period (2014-2015).
- Child Opportunity Index (COI) was determined by patient's 2010 Census Tract and grouped from 1 (very low) to 5 (very high).
Main Results:
- Pediatric intensive care unit delirium (PD) was present in 193 of 1264 patients.
- PD rates were highest in Asian/Pacific Islander, Black non-Hispanic, and Hispanic children compared to White non-Hispanic children.
- Higher PD prevalence was observed in patients from lower COI groups (1-3) compared to higher groups (4-5).
- Lower COI was associated with greater adjusted odds of delirium (aOR 1.55, 95% CI 1.05-2.3).
Conclusions:
- An association exists between lower Child Opportunity Index (COI) and increased odds of delirium in the pediatric intensive care unit.
- This finding highlights the potential impact of socioeconomic and environmental factors on pediatric critical care outcomes.
- Further research is warranted to explore the mediators of this association.
Objectives:
To explore the association between geospatial determinants of health and prevalence of delirium in the PICU.
Design:
Nonprespecified secondary analysis of an observational study dataset.
Setting:
Urban academic tertiary care PICU.
Patients:
All children admitted over a 12-month period in 2014-2015.
Interventions:
None.
Measurements And Main Results:
Of 1547 admissions, there were individual 1264 patients, with race and ethnicity subgroup recorded for 961 (76%), insurance status for 1240 (98%), and language for 1227 (97%). Child Opportunity Index (COI) was determined by a patient's 2010 Census Tract and was available for 1246 (98%). Data were grouped from 1 to 5 (very low to very high). PICU delirium (PD) was present in 193 patients during PICU admission, with PD rates highest in Asian/Pacific Islander, Black non-Hispanic, and Hispanic (respectively, 26, 29, and 39 patients) as compared with White non-Hispanic children ( n = 45; p < 0.001). PD was higher for patients with public insurance (113/573 [20%]) compared with those with private insurance (67/583 [12%]) and those with "other" (8/84 [10%]) forms of support ( p < 0.001). We failed to identify a difference in delirium rates by language preference. A higher prevalence of delirium was present among patients in the lowest COI groups (1-3) as compared with highest (4-5; 135/748 [18%] vs. 55/494 [11%]; p = 0.003). In multivariable analysis, COI was associated with greater adjusted odds of delirium (after adjusting for other demographic and clinical predictors of delirium, including age, developmental disability, severity of illness at admission, need for invasive mechanical ventilation, depth of sedation, and medication exposures), with adjusted odds ratio of 1.55 (95% CI, 1.05-2.3; p = 0.028).
Conclusions:
In a 2014-2015 PICU dataset, we have identified an association between lower COI and greater adjusted odds of delirium. This finding calls for further study to investigate potential mediators of this relationship.
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