Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States
Michael C. McCrory, Manzilat Akande, Katherine N. Slain, Curtis E. Kennedy, Meredith C. Winter, Morgan G. Stottlemyre, Martin K. Wakeham, Kyle A. Barnack, Jia Xin Huang, Meesha Sharma, Adrian D. Zurca, Neethi P. Pinto, Adam C. Dziorny, Aline B. Maddux, Anjali Garg, Alan G. Woodruff, Mary E. Hartman, Otwell D. Timmons, R. Scott Heidersbach, Michael J. Cisco, Anthony A. Sochet, Brian J. Wells, Elizabeth E. Halvorson, Amit K. Saha,- Critical Care and Intensive Care Medicine
- Pediatrics, Perinatology and Child Health
Objectives:
To evaluate for associations between a child’s neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS).
Design:
Retrospective cohort study.
Setting:
Fifteen PICUs in the United States.
Patients:
Children younger than 18 years admitted from 2019 to 2020, excluding those after cardiac procedures. Nationally-normed COI category (very low, low, moderate, high, very high) was determined for each admission by census tract, and clinical features were obtained from the Virtual Pediatric Systems LLC (Los Angeles, CA) data from each site.
Interventions:
None.
Measurements and Main Results:
Among 33,901 index PICU admissions during the time period, median patient age was 4.9 years and PICU mortality was 2.1%. There was a higher percentage of admissions from the very low COI category (27.3%) than other COI categories (17.2–19.5%,
Conclusions:
Children admitted to a cohort of U.S. PICUs were often from very low COI neighborhoods. Children from very high COI neighborhoods had the lowest risk of mortality and observed mortality; however, odds of mortality were not statistically different by COI category in a multivariable model. Children without insurance coverage had significantly higher odds of PICU mortality regardless of neighborhood.