The Association of Neighborhood Social Vulnerability and Pediatric Acute Respiratory Failure
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Worldwide Data, Pulmonary, Pediatrics, 2022
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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
neighborhood social vulnerability
pediatric acute respiratory failure
social determinants of health
health inequities
hotspot neighborhoods


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