SCCM Resource Library-The Association of Neighborhood Social Vulnerability and Pediatric Acute Respiratory Failure

Video Transcription

Good morning. My name is Nadine Najjar, and I'm here to present our team's work entitled the Association  of Neighborhood Social Vulnerability and Pediatric Acute Respiratory Failure. To start, I will share a little bit about myself.  I completed pediatric residency at Emory University, and I am a current chief resident here. I am looking forward to starting Pediatric Critical Care Medicine Fellowship in July  here at Emory as well. And my research interests include global health, health disparities, and pediatric critical care outcomes.  Social determinants of health are defined as the conditions in which people are born, grow, live, work, and age.  Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world.  Some social determinants of health are depicted here and include education access and quality, health care access, neighborhood and built environment characteristics, and economic  stability. However, there are many more that are not listed here. Differences in these conditions lead to health inequities or the unfair and avoidable differences  in health status seen within and between communities and countries. While the effects of social determinants of health have been studied in other areas of  pediatrics, we have limited understanding of the interplay between the social determinants of health and pediatric critical illness.  Now I'd like to introduce the concept of social vulnerability. Social vulnerability refers to the potential negative effects on communities caused by  external stresses on human health. Many factors contribute to social vulnerability, and this graphic depicts many of the factors that are included in this measure.  The CDC uses U.S. census data to determine social vulnerability for each census tract. This measure is called the Social Vulnerability Index, or SVI.  The CDC SVI ranks each tract on 15 social factors centered around four major themes seen here, including socioeconomic status, household composition and disability, minority  status and language, and housing type and access to transportation. Each tract is ranked on each of these four themes, as well as an overall ranking of social vulnerability.  The higher the ranking, the more socially vulnerable a community is deemed to be. Our study is meant to identify socially vulnerable neighborhoods with higher proportions of  children with acute respiratory failure that require PICU admission. Prior studies have shown higher odds of worse outcomes for Black or Hispanic children with  acute respiratory failure, and existing structural determinants pervasive in socially vulnerable communities may explain these disproportionately higher odds.  As such, our goals were to identify hotspot neighborhoods for pediatric acute respiratory  failure, which we defined as greater than or equal to the 90th percentile for PICU admissions  per 1,000 children in the census tract, as well as to compare social vulnerability indices of hotspot versus non-hotspot neighborhoods.  In order to achieve our aims, we geocoded patient residences to census tracts and linked this information to Georgia-ranked SVI data.  We then compared hotspot versus non-hotspot neighborhoods using SVI data. Then we also determined the inpatient bed day rate for hotspot versus non-hotspot residents,  and this is defined as inpatient bed days per 1,000 children. Now moving on to our results. So our study population was comprised of 3,514 children admitted to the PICU for acute  respiratory failure. The map depicts all of these children that were included in our study and the neighborhoods that they came from.  9.7% of our study population live in hotspots, and of those who do live in these neighborhoods, more children identify as black and more children receive public insurance compared  to non-hotspot counterparts. Of note, there were no statistically significant differences in age, sex, ethnicity, primary  spoken language, or discharge disposition when comparing hotspot versus non-hotspot groups.  Our findings show that social vulnerability varied significantly in hotspot versus non-hotspot  neighborhoods, and the map shown here depicts those SVI rankings of census tracts throughout the metro Atlanta area.  And as you can see, the neighborhoods north of the city center generally have lower SVI rankings depicted with shades of purple and blue.  South of the city center, you see higher SVI rankings overall, depicted by shades of green.  Our findings show that hotspot neighborhoods exhibit significantly higher social vulnerability compared to non-hotspot neighborhoods.  In order to delve a little bit deeper into the SVI data for our study population, this table depicts comparison of SVI data by hotspot residents.  So the four SVI themes, as well as the overall percentile ranking are shown here on the left,  and our findings show statistically significant differences in themes one, two, and four, as well as differences in overall SVI ranking.  And those themes include socioeconomic status, household composition and disability, and housing type and transportation.  In other words, our patients living in hotspots are also living in more socially vulnerable neighborhoods than their non-hotspot counterparts.  Finally, we explored outcomes for our study population as well. And as you can see in this table, children living in hotspot neighborhoods contributed  to more total inpatient bed days and a higher inpatient bed day rate compared to non-hotspot counterparts.  There was no difference in the proportion of children who died or an individual child's hospital length of stay.  And as well, there was no significant difference in children with multiple admissions or time to readmission when compared by hotspot status.  In order to look at how the census tracked with a higher versus lower total inpatient bed day rate differed by social vulnerability themes, we dichotomized the variable into  those neighborhoods with total inpatient bed days per 1,000 children greater than or equal to the 90th percentile versus those less than the 90th percentile.  Neighborhoods with the highest number of total inpatient bed days per 1,000 children had higher social vulnerability in all four themes, including socioeconomic status, household  composition and disability, minority status and language, and housing type and transportation, as well as the overall SVI ranking.  Therefore, hotspot neighborhoods not only have higher social vulnerability compared to non-hotspots, but also neighborhoods with high total inpatient bed day rates also have  higher social vulnerability compared to their counterparts. Our study highlighted the relationship between social vulnerability and outcomes in our study population.  However, it was limited by the following factors. Our study was composed of a heterogeneous population of all children intubated for greater  than one day, identified from the electronic record. We identified an association with this analysis, but are unable to comment on causation.  And while we captured a significant relationship using SVI data, other indices such as the Child Opportunity Index exist, and inclusion of such indices may be helpful in further  fleshing out the effects of social determinants of health in pediatric critical illness. Finally, while we may comment on negative factors associated with outcomes, we were  really unable to discover any protective factors associated with neighborhood data, and those may be useful to actually affect change.  In conclusion, large disparities exist between hotspot and non-hotspot neighborhoods in the metro Atlanta area.  The use of SVI highlights the multidimensional factors associated with health disparities.  Moving forward, this data can bolster community and policy efforts aimed at improving neighborhood  conditions and improving conditions upstream from PICU admission in order to improve outcomes and reduce health disparities.  I would like to thank you all so much for giving me the time to speak on this important topic, and I would also like to acknowledge the funding sources for this project listed here.  This project is supported by the Emory Department of Pediatrics and Children's Healthcare of Atlanta. And once again, thank you so much, and I look forward to your questions.

Video Summary

The video transcript discusses a study on the association between neighborhood social vulnerability and pediatric acute respiratory failure. Social determinants of health, such as education, healthcare access, and economic stability, can lead to health inequities. The study aimed to identify socially vulnerable neighborhoods with high rates of pediatric acute respiratory failure. The findings showed that hotspot neighborhoods had significantly higher social vulnerability compared to non-hotspot neighborhoods. Children in hotspot neighborhoods also had more inpatient bed days and a higher bed day rate. The study suggests that addressing neighborhood conditions and social determinants of health can help improve outcomes and reduce health disparities.

Asset Subtitle

Worldwide Data, Pulmonary, Pediatrics, 2022

Asset Caption

INTRODUCTION: Social determinants of health are linked to adverse health outcomes for critically children in the U.S., but are neglected in our understanding of pediatric critical illness. Social vulnerability encompasses the negative effects on communities caused by external stresses on human health, and is quantified by the Centers for Disease Control (CDC) using U.S. Census data to determine the Social Vulnerability Index (SVI) of every census tract. Our objective is to examine whether there is an association between the SVI for Georgia census tracts with the highest rates of critically ill children admitted for acute respiratory failure to intensive care in Atlanta, Georgia.
METHODS: We conducted a population-level, retrospective analysis of intubated children aged 17 years or younger admitted to intensive care between 1/1/2015-5/31/2020. Patient residential addresses were geocoded and joined to census tract data. High admission rate neighborhoods were defined as a census tract with greater than or equal to the 90th-percentile of children admitted per 1000 children residing within the census tract. The overall SVI including the four SVI themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation were compared by high versus low neighborhood admission rate status using two-sided Welch two-sample t-tests.
RESULTS: There were 3,581 unique children included in the cohort. The median age was 3 years (IQR 0.7-9.8) with 56% male, 49% Black or Multi-racial, 41% White, and 84% non-Hispanic. A higher overall SVI was associated with high versus low admission rates by census tract (MD: 0.13, 95% CI: 0.08-0.18, p < 0.0001). For the individual SVI themes, socioeconomic status (MD: 0.16, 95% CI: 0.11 – 0.21, p < 0.0001), minority status and non-English language (MD: 0.10, 95% CI: 0.05-0.15, p=0.0002), and housing type and transportation (MD: 0.10, 95% CI: 0.05-0.15, p=0.00015) were ranked higher within the high versus low admission rate group.
CONCLUSIONS: Neighborhoods with the highest social vulnerability are associated with greater pediatric intensive care use for acute respiratory failure. Interventions addressing the themes of neighborhood social vulnerability should be explored to devise strategies to prevent disparities in intensive care use.

Meta Tag

Content Type Presentation

Knowledge Area Pulmonary

Knowledge Area Pediatrics

Knowledge Area Worldwide Data

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Epidemiology Outcomes

Tag Respiratory Failure

Tag Pediatrics

Year 2022

Keywords

neighborhood social vulnerability

pediatric acute respiratory failure

social determinants of health

health inequities

hotspot neighborhoods

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