Journal of Community Health

, Volume 39, Issue 4, pp 753–759 | Cite as

The Effect of Neighborhood and Individual Characteristics on Pediatric Critical Illness

  • David Epstein
  • Michael Reibel
  • Jennifer B. Unger
  • Myles Cockburn
  • Loraine A. Escobedo
  • David C. Kale
  • Jennifer C. Chang
  • Jeffrey I. Gold
Original Paper

Abstract

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.

Keywords

Neighborhood Geocoding Pediatric Intensive care Health care disparities 

Abbreviations

ICU

Intensive care unit

PICU

Pediatric intensive care unit

Notes

Acknowledgments

This study was supported by a grant from the Southern California Clinical Translational Science Institute Los Angeles Basin (SC-CTSI LAB) Pilot Award (NIH/NCRR/NCATS SC CTSI—Grant Number UL1 RR031986).

Conflict of interest

The authors of this article have no relevant financial relationships or conflicts of interest as they relate to the research of this study.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • David Epstein
    • 1
  • Michael Reibel
    • 4
  • Jennifer B. Unger
    • 2
  • Myles Cockburn
    • 2
  • Loraine A. Escobedo
    • 2
  • David C. Kale
    • 1
  • Jennifer C. Chang
    • 1
  • Jeffrey I. Gold
    • 1
    • 3
  1. 1.Department of Anesthesiology Critical Care Medicine, Keck School of Medicine, Children’s Hospital Los AngelesUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Departments of Anesthesiology and Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Department of Geography and AnthropologyCalifornia State Polytechnic University – PomonaPomonaUSA

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