Pediatric Health Disparities: The Role of Built Environment on Pediatric Critical Illness
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Research, Administration, Pediatrics, 2022
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INTRODUCTION: Socioeconomic position (SEP) at the individual level has been shown to influence health outcomes in children; however, few studies have investigated the role of SEP in the critically ill pediatric population. Emerging evidence highlights the importance of neighborhood-level SEP in the health of children, but the influence of neighborhood-level disparities on pediatric critical illness has yet to be described. Focusing on neighborhood as a domain effecting health outcomes, we examined the association between indicators of neighborhood-level SEP and rates of pediatric critical illness. METHODS: We conducted an ecologic study of patients ages 0-18 years who were admitted to the Johns Hopkins pediatric intensive care unit (PICU) between January 1, 2016, and December 31, 2019, and resided within Baltimore City or County.  Unadjusted negative binomial regression models were used to examine the association between census tract (CT)-level PICU admission rates (per 1000 population < 18 years of age) and CT-level indicators of SEP, reported as incidence rate ratios (IRR) with corresponding 95% confidence intervals (CI). RESULTS: PICU admissions included 1351 from Baltimore City (10.25 per 1000 children) and 1125 from Baltimore County (6.31 per 1000 children). At the CT level, PICU admission rates were associated with a higher percentage of families living below poverty in Baltimore City (IRR=1.09; 95%CI: 1.00, 1.18) and County (IRR=1.19; 95%CI: 1.05, 1.36). Similarly, a 10% increase in occupied homes without vehicles was associated with higher PICU admission rates in Baltimore City (IRR=1.14; 95%CI: 1.07, 1.21) and County (IRR=1.23; 95%CI: 1.11, 1.37), as well as for vacant housing units (IRR=1.10; 95%CI: 1.01, 1.21 and IRR: 1.46; 95%CI: 1.21, 1.77). Increases in median household income by $10,000 were associated with lower PICU admission rates for Baltimore City (IRR=0.91; 95%CI: 0.86, 0.95) and County (IRR=0.91; 95%CI: 0.88, 0.94). CONCLUSION: Pursuing an understanding of geo-demographics and place-based disparities, specifically housing quality and conditions, transportation, and poverty, in relation to pediatric critical illness offers a sub-framework for disparities research. Understanding the interplay between place and health allows for tailored community-level interventions to improve pediatric health.
Meta Tag
Content Type Presentation
Knowledge Area Research
Knowledge Area Administration
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Outcomes Research
Tag Patient and Family Support
Tag Pediatrics
Year 2022
pediatric health disparities
built environment
socioeconomic position
neighborhood levels
pediatric health outcomes


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