Poor children are far more likely to end up in the PICU than are affluent children

It’s widely known socioeconomic status correlates with measures of health; rich people have better overall health and even longer lifespans than do poorer people. Of course there are several reasons this might be the case, including better access to healthcare for chronic problems, better diet opportunities (Google “food deserts” to learn more about that), and better living environments. Using Medicaid as a surrogate for socioeconomic status, it’s been shown children on Medicaid are much more likely to end up in a PICU than are more affluent children. I’ve written about that before. The Medicaid data are sort of a 50,000 foot high view of the issue. Now a recent study from the Cincinnati PICU entitled “Neighborhood Poverty and Pediatric Intensive Care Use” focuses on a specific local region — a view from the ground. It provides a useful case study of the issue.

The authors looked at 4,071 admissions to the PICU that led to a total of 12,297 patient days. They only evaluated children from Hamilton County, the county around Cincinnati. They then matched the children to the poverty rates in the neighborhoods they lived in using census tracts. It’s a pretty crude, yet straightforward measure to answer the question they’re asking. The results are a bit noisy and can best be appreciated with simple scatter plots:

Child poverty was significantly associated with PICU admission (p < 0.001). When the PICU admission days were grouped into quintiles, the most affluent quintile had 23 days per 1,000 children and the poorest quintile had 82 days per 1,000 children. That’s a pretty striking difference — 350% higher in the poorest children.

I think the strength of this simple study is that it puts a local face on a phenomenon that has previously been studied by state or nationally. The implication is clear: if we want healthier children and lower healthcare costs, we should focus on childhood poverty. The returns on investing in this would be huge.


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