Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Acute Respiratory Failure Requiring Mechanical Ventilation*

Abstract

OBJECTIVES: Poverty, racial bias, and disparities are linked to adverse health outcomes for children in the United States. The social vulnerability and child opportunity indices are composite measures of the social, economic, education, health, and environmental qualities that affect human health for every U.S. census tract. Composite measures of social vulnerability and child opportunity were compared for neighborhood hot spots, where PICU admissions for acute respiratory failure requiring invasive mechanical ventilation were at the 90th percentile or greater per 1,000 children, versus non-hot spots. DESIGN:Population-based ecological study. SETTING:Two urban free-standing children's hospital PICUs consisting of a 36-bed quaternary academic and a 56-bed tertiary community center, in Atlanta, GA. PATIENTS:Mechanically ventilated children who were 17 years of age or younger with a geocodable Georgia residential address admitted to a PICU for at least 1 day. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Residential addresses were geocoded and spatially joined to census tracts. Composite measures of social vulnerability and childhood opportunity, PICU readmission rates, and hospital length of stay were compared between neighborhood hot spots versus non-hot spots. There were 340 of 3,514 children (9.7%) who lived within a hot spot. Hot spots were associated with a higher (worse) composite social vulnerability index ranking, reflecting differences in socioeconomic status, household composition and disability, and housing type and transportation. Hot spots also had a lower (worse) composite childhood opportunity index percentile ranking, reflecting differences in the education, health and environment, and social and economic domains. Higher social vulnerability and lower childhood opportunity were not associated with readmission rates but were associated with longer total median duration of hospital days per 1,000 children in a census tract.CONCLUSIONS: Social determinants of health identified by geospatial analyses are associated with acute respiratory failure requiring invasive mechanical ventilation in critically ill children. Interventions addressing the neighborhood social vulnerability and child opportunity are needed to decrease disparities in intensive care admissions for acute respiratory failure requiring mechanical ventilation.

Reporting of Social Determinants of Health in Pediatric Sepsis Studies*

“…Given that numerous studies have documented the importance of SDOH on outcomes of critically ill children across the globe (2,3,5,8,20,23,24,70,(73)(74)(75), researchers have a collective responsibility to design studies to include SDOH variables so as not to perpetuate implicit and explicit biases regarding minoritized groups and to ensure consistent and standardized collection and reporting of these variables when conducting future studies in pediatric sepsis.…”

Editor’s Choice Articles for August

“…However, if you started with my sequence of Editor's Choices, then here are some PCCM Connections for regular readers. First, look at the article on social determinants of health associated with acute respiratory failure requiring mechanical ventilation in pediatric patients with a residential address in Georgia (12). The accompanying editorial makes us think about micro-level (i.e., individual) and macro-level (i.e., neighborhood) social risks in critical illness (13).…”

County-Level Maternal Vulnerability and Preterm Birth in the US

“…Some studies have used composite indices such as the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) 22 to assess how community factors influence health outcomes, including PTB. [23][24][25][26] However, neighborhood or community-level indices specific to maternal health and PTB have not been examined.…”