• 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, and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Social Determinants of Health Subgroup.
• Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC.
• Pediatr Crit Care Me. 2024 Apr 1; 25 (4): 323334323-334.

ObjectivesTo 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).DesignRetrospective cohort study.SettingFifteen PICUs in the United States.PatientsChildren 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.InterventionsNone.Measurements And Main ResultsAmong 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%, p < 0.0001). Patient admissions from the high and very high COI categories had a lower median Pediatric Index of Mortality 3 risk of mortality (0.70) than those from the very low, low, and moderate COI groups (0.71) ( p < 0.001). PICU mortality was lowest in the very high (1.7%) and high (1.9%) COI groups and highest in the moderate group (2.5%), followed by very low (2.3%) and low (2.2%) ( p = 0.001 across categories). Median PICU LOS was between 1.37 and 1.50 days in all COI categories. Multivariable regression revealed adjusted odds of PICU mortality of 1.30 (95% CI, 0.94-1.79; p = 0.11) for children from a very low versus very high COI neighborhood, with an odds ratio [OR] of 0.996 (95% CI, 0.993-1.00; p = 0.05) for mortality for COI as an ordinal value from 0 to 100. Children without insurance coverage had an OR for mortality of 3.58 (95% CI, 2.46-5.20; p < 0.0001) as compared with those with commercial insurance.ConclusionsChildren 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.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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