Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Acute Respiratory Failure Requiring Mechanical Ventilation.
Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Acute Respiratory Failure Requiring Mechanical Ventilation.
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DOI：
10.1097/pcc.0000000000002986
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发表时间：
2022-08-01
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贫困、种族偏见和不平等与美国儿童的不良健康结果有关。社会脆弱性和儿童机会指数是影响美国每个人口普查区域人类健康的社会、经济、教育、健康和环境质量的综合衡量标准。社区热点地区的社会脆弱性和儿童机会的综合指标进行了比较，与非热点地区相比，需要有创机械通气的急性呼吸衰竭的儿科重症监护病房入院率为每1,000名儿童的第90百分位数或更高。基于人口的生态学研究。格鲁吉亚亚特兰大市的两个城市独立儿童医院儿科重症监护室，包括一个36张床位的四级学术中心和一个56张床位的三级社区中心。没有。对居住地址进行了地理编码，并在空间上与人口普查区相连。社区热点与非热点之间的社会脆弱性和儿童机会，PICU再入院率和住院时间的综合措施进行了比较。340/3，514（9.7%）名儿童居住在热点地区。热点地区的综合社会脆弱性指数排名较高（较差），反映了社会经济地位、家庭组成和残疾、住房类型和交通方面的差异。热点地区的儿童机会综合指数百分位数排名也较低（较差），反映了教育、卫生和环境以及社会和经济领域的差异。较高的社会脆弱性和较低的儿童机会与再入院率无关，但与人口普查区每1000名儿童住院天数的总中位数较长相关。通过地理空间分析确定的健康的社会决定因素与危重儿童需要有创机械通气的急性呼吸衰竭相关。需要针对社区社会脆弱性和儿童机会的干预措施，以减少需要机械通气的急性呼吸衰竭重症监护入院的差异。生活在格鲁吉亚社区的插管儿童具有较高的社会脆弱性和较低的儿童机会与较长的人均住院时间相关。
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 impact human health for every U.S. census tract. Composite measures of social vulnerability and child opportunity were compared for neighborhood hot spots, where pediatric intensive care unit admissions for acute respiratory failure requiring invasive mechanical ventilation were at the 90th percentile or greater per 1,000 children, versus non-hot spots. Population-based ecological study. Two urban free-standing children’s hospital pediatric intensive care units consisting of a 36-bed quaternary academic and a 56-bed tertiary community center, in Atlanta, Georgia. None. 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 340/3,514 (9.7%) children 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 1000 children in a census tract. 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. Intubated children living in Georgia neighborhoods with higher social vulnerability and lower child opportunity are associated with longer per capita hospital stays.