Socioeconomic/Ethnic Disparities Adversely Affect Pediatric ICU Outcomes

Pediatric intensive care unit (PICU) outcomes from respiratory diseases are adversely influenced by disparities in children’s household income, ethnicity, and environment, according to a systematic review published in Pediatric Pulmonology.

Children across the world from minority backgrounds and those whose families have low income comprise a higher proportion of PICU admissions for respiratory diseases and are at higher risk for mortality. Researchers at the Emma Children’s Hospital in Amsterdam, Netherlands, therefore sought to determine whether outcomes of children’s respiratory diseases treated at the PICU are adversely influenced by disparities in household income, environment, sex, and ethnicity.

The researchers searched for studies with data on socioeconomic, ethnic, sex, or environmental disparities in patients less than 18 years of age (excluding premature infants) who were admitted to the PICU with a respiratory disease-related primary diagnosis. The search involved the Embase, Web of Science Core Collection, and PubMed databases, from inception through September 2022. Studies involving premature infants were excluded.

The review identified 15 articles (7 on the effect of socioeconomic status; 5 concerning ethnicity; 1 on the effect of sex; 2 concerning environmental factors). The investigators noted all but 1 article showed associations between these factors and adverse PICU outcomes.

The investigators found a significant proportion of PICU admissions (more than 60% in 1 study) were children from deprived neighborhoods, and that this population more frequently received mechanical ventilation and experienced the highest proportion of deaths. Multiple studies indicated that children with severe bronchiolitis coming from households with low-income vs children raised above poverty thresholds experienced longer lengths of stay at the PICU and an increased need for mechanical ventilation.

Overall, the investigators found that living in poverty, being part of an ethnic minority, and living in a deprived area were all negatively correlated with mortality, longer PICU stays, and the need for mechanical ventilation among children in the PICU with acute respiratory diseases.

Study authors noted that children with public health insurance vs those with commercial or HMO insurance as well as those admitted with severe asthma were significantly more likely to receive mechanical ventilation and to have a longer length of stay in the PICU, with longer use of mechanical ventilation.

The investigators found that in the US, Black children vs those of other races/ethnicities admitted to the PICU were significantly more likely to be intubated. No association was found between respiratory failure and sex, age, or obesity. The investigators noted children exposed to environmental tobacco smoke vs those not exposed experienced significantly longer lengths of stay in the PICU.

Review limitations include the high heterogeneity between included studies regarding population, type of disease, and the inequality being addressed; the risk for subjective interpretation of outcome data; and publication bias.

“This review demonstrates that inequalities in children with respiratory diseases at the PICU exist and may have a considerable effect on their morbidity and even mortality when admitted,” review authors concluded. They added that “With increasing child‐poverty numbers and the current recession, we should be looking more closely into these vulnerable patient groups and look for measures on how to prevent these detrimental effects.”

This article originally appeared on Pulmonology Advisor