Date: 01 Feb 2014
The Effect of Neighborhood and Individual Characteristics on Pediatric Critical Illness
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The relationship between neighborhood/individual characteristics and pediatric intensive care unit (PICU) outcomes is largely unexplored. We hypothesized that individual-level racial/ethnic minority status and neighborhood-level low socioeconomic status and minority concentration would adversely affect children’s severity of illness on admission to the PICU. Retrospective analyses (1/1/2007–5/23/2011) of clinical, geographic, and demographic data were conducted at an academic, tertiary children’s hospital PICU. Clinical data included age, diagnosis, insurance, race/ethnicity, Pediatric Index of Mortality 2 score on presentation to the PICU (PIM2), and mortality. Residential addresses were geocoded and linked with 2010 US Census tract data using geographic information systems geocoding techniques. Repeated measures models to predict PIM2 and mortality were constructed using three successive models with theorized covariates including the patient’s race/ethnicity, the predominant neighborhood racial/ethnic group, interactions between patient race/ethnicity and neighborhood race/ethnicity, neighborhood socioeconomic status, and insurance type. Of the 5,390 children, 57.8 % were Latino and 70.1 % possessed government insurance. Latino children (β = 0.31; p < 0.01), especially Latino children living in a Latino ethnic enclave (β = 1.13; p < 0.05), had higher PIM2 scores compared with non-Latinos. Children with government insurance (β = 0.29; p < 0.01) had higher PIM2 scores compared to children with other payment types and median neighborhood income was inversely associated with PIM2 scores (β = −0.04 per $10,000/year of income; p < 0.05). Lower median neighborhood income, Latino ethnicity, Latino children living in a predominantly Latino neighborhood, and children possessing government insurance were associated with a higher severity of illness on PICU admission. The reasons why these factors affect critical illness severity require further exploration.
Institute of Medicine (U.S.). (2003). Committee on understanding and eliminating racial and ethnic disparities in health care. In B. D. Smedley, A. Y. Stith, & A. R. Nelson (Eds.), Unequal treatment confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.
Epstein, A. M., Ayanian, J. Z., Keogh, J. H., et al. (2000). Racial disparities in access to renal transplantation–clinically appropriate or due to underuse or overuse? The New England Journal of Medicine, 343(21), 1537–1544, 1532 p preceding 1537.
Haider, A. H., Efron, D. T., Haut, E. R., DiRusso, S. M., Sullivan, T., Cornwell, E. E., III. (2007). Black children experience worse clinical and functional outcomes after traumatic brain injury: an analysis of the National Pediatric Trauma Registry. Journal of Trauma, 62(5), 1259–1262; discussion 1262–1253.
Wisnivesky, J. P., Krauskopf, K., Wolf, M. S., et al. (2012). The association between language proficiency and outcomes of elderly patients with asthma. Annals of Allergy, Asthma & Immunology, 109(3), 179–184.CrossRef
Reibel, M. (2007). Geographic information systems and spatial data processing in demography: a review. Population Research and Policy Review, 26, 601–618.CrossRef
Pitblado, J. R., & Pong, R. W. (1999). Geographic distribution of physicians in Canada. Sudbury: Laurentian University Centre for Rural and Northern Health Research.
Watson, D., Black, C., & Reid, R. (2006). Primary health care in BC: Physician supply, distribution and practice collocation (1996/97 to 2004/05). Vancouver: UBC Centre for Health Services and Policy Research.
Slater, A., Shann, F., & Pearson, G. (2003). PIM2: a revised version of the paediatric index of mortality. Intensive Care Medicine, 29(2), 278–285.PubMed
Goldberg, D. W. (Ed.). Texas A&M University Geoservices. http://geoservices.tamu.edu.
Overview of Race and Hispanic Origin. (2010). United States Census Bureau. 2010. http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf. Accessed December 5 2013.
Profile of General Population and Housing Characteristics. (2010). Demographic Profile Data (Los Angeles County, California). United States Census Bureau. 2010. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1. Accessed December 5 2013.
Roy, A. L., Hughes, D., Yoshikawa, H. (2013). Intersections between nativity, ethnic density, and neighborhood SES: Using an ethnic enclave framework to explore variation in Puerto Ricans’ Physical Health. American journal of Community Psychology. (Epub ahead of print).
United States Population Projections: 2000 to 2050. United States Census Bureau. 2008. http://www.census.gov/population/projections/files/analytical-document09.pdf. Accessed December 5 2013.
- The Effect of Neighborhood and Individual Characteristics on Pediatric Critical Illness
Journal of Community Health
Volume 39, Issue 4 , pp 753-759
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Intensive care
- Health care disparities
- Author Affiliations
- 1. Department of Anesthesiology Critical Care Medicine, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Boulevard, MS #3, Los Angeles, CA, 90027, USA
- 4. Department of Geography and Anthropology, California State Polytechnic University – Pomona, Pomona, CA, USA
- 2. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- 3. Departments of Anesthesiology and Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA