Neighborhood Poverty and Pediatric Intensive Care Use
Neighborhood Poverty and Pediatric Intensive Care Use
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DOI：
10.1542/peds.2019-0748
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发表时间：
2019-12-01
期刊：
影响因子：
8
通讯作者：
Beck, Andrew F.
中科院分区：
文献类型：
--
作者：
Andrist, Erica;Riley, Carley L.;Beck, Andrew F.
背景：卫生服务使用的差异已经在一系列社会人口学因素中得到了描述。PICU的使用模式尚未得到彻底评估。方法：这是一项人口水平的回顾性分析，对2011年至2016年期间辛辛那提儿童医院医学中心PICU的入院情况进行分析。对患者的居住地址进行了地理编码，并在空间上与人口普查区相连。如果儿童患者居住在俄亥俄州的汉密尔顿县，则有资格入选。PICU入院率和住院日率分别用入院率和住院日的分子除以儿科儿童人口的分母计算。使用斯皮尔曼rho和方差分析评估了儿科重症监护室使用和儿童贫困之间的关系。分析基于事件;结果：共纳入4071例住院患儿，其中3129例为独立住院患儿，共计12297个PICU床位日。儿童贫困与PICU入院率（r = 0.59; P <0.001）和床日率（r = 0.47; P <0.001）呈正相关。当根据儿童贫困率将大片分为五分之一时，PICU床日率从最低贫困五分之一的每1000名儿童23.4天到最高贫困五分之一的81.9天不等（P < .001）。该协会为在贫困中和贫困周围长大的儿童而设。未来的努力应该表征患者和社区水平的风险因素之间的相互作用，并探讨社区水平的干预措施，以改善儿童健康。
BACKGROUND: Disparities in health service use have been described across a range of sociodemographic factors. Patterns of PICU use have not been thoroughly assessed.METHODS: This was a population-level, retrospective analysis of admissions to the Cincinnati Children's Hospital Medical Center PICU between 2011 and 2016. Residential addresses of patients were geocoded and spatially joined to census tracts. Pediatric patients were eligible for inclusion if they resided within Hamilton County, Ohio. PICU admission and bed-day rates were calculated by using numerators of admissions and bed days, respectively, over a denominator of tract child population. Relationships between tract-level PICU use and child poverty were assessed by using Spearman's rho and analysis of variance. Analyses were event based; children admitted multiple times were counted as discrete admissions.RESULTS: There were 4071 included admissions involving 3129 unique children contributing a total of 12297 PICU bed days. Child poverty was positively associated with PICU admission rates (r = 0.59; P < .001) and bed-day rates (r = 0.47; P < .001). When tracts were grouped into quintiles based on child poverty rates, the PICU bed-day rate ranged from 23.4 days per 1000 children in the lowest poverty quintile to 81.9 days in the highest poverty quintile (P < .001).CONCLUSIONS: The association between poverty and poor health outcomes includes pediatric intensive care use. This association exists for children who grow up in poverty and around poverty. Future efforts should characterize the interplay between patient- and neighborhood-level risk factors and explore neighborhood-level interventions to improve child health.