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The Association Between Neighborhood Factors and Early Organ Dysfunction in Children Who Are Critically Ill: A
Paula M Magee1, Erin Paquette2, Latasha A Daniels3
1Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA; Children's Hospital of Philadelphia PolicyLab, Philadelphia, PA; Leonard Davis Institute for Health Policy Economics, University of Pennsylvania, Philadelphia, PA.
Insights
Social vulnerability in neighborhoods is linked to worse early organ dysfunction in critically ill children. Other neighborhood factors like opportunity and disorder showed no association in this study.
Area of Science:
- Pediatric Critical Care Medicine
- Social Determinants of Health
- Environmental Epidemiology
Background:
- Understanding neighborhood factors influencing pediatric critical illness is crucial.
- Early organ dysfunction is a significant concern in critically ill children.
Purpose of the Study:
- To investigate associations between neighborhood characteristics and early organ dysfunction in critically ill children.
- To examine the impact of the Child Opportunity Index (COI), Social Vulnerability Index (SVI), and Neighborhood Disorder Index (NDI) on pediatric organ dysfunction.
Main Methods:
- Retrospective ecological cohort study of 8289 pediatric critical care encounters.
- Neighborhood factors measured using COI, SVI, and NDI.
- Early organ dysfunction assessed by Peak Pediatric Logistic Organ Dysfunction (PELOD)-2 scores within 72 hours.
- Adjusted Poisson regression with robust modeling was employed.
Main Results:
- No significant association was found between COI or NDI and peak PELOD-2 scores.
- A significant association was identified between very high SVI and greater peak PELOD-2 scores (P = .004).
- Most encounters were from neighborhoods with very low opportunity, very high vulnerability, or very high physical disorder.
Conclusions:
- Neighborhood social vulnerability, but not opportunity or disorder, is associated with worse early organ dysfunction in critically ill children.
- Further research is needed to identify specific neighborhood elements driving organ dysfunction in pediatric critical illness.
Objective:
To explore potential associations between neighborhood-level factors and early organ dysfunction in children who are critically ill.
Study Design:
This retrospective, ecological cohort study assessed the association between neighborhood factors and early organ dysfunction in 8289 encounters for children who were critically ill from January 2013 to December 2019 at a quaternary pediatric hospital in an urban setting. The exposures were neighborhood factors, which were measured using 3 composite indices: Child Opportunity Index (COI), Social Vulnerability Index (SVI), and Neighborhood Disorder Index (NDI). Peak Pediatric Logistic Organ Dysfunction [PELOD]-2 scores in the first 72 hours measured early organ dysfunction as the primary outcome. An adjusted Poisson regression with robust modeling was used to measure the association.
Results:
Most encounters were for patients from very low opportunity (28%), very high vulnerability (29%), and very high physical disorder neighborhoods (27%). Median peak PELOD-2 score was 3 (interquartile range 2-5). No association was identified for COI or NDI with peak PELOD-2 scores; however, there was an association between a very high SVI and greater peak PELOD-2 scores (P = .004).
Conclusions:
No association was found among COI or NDI with worse early organ dysfunction. Very high SVI was associated with worse early organ dysfunction. Further studies should assess whether specific aspects of neighborhoods drive critical illness in organ-specific diseases.
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