Department of Critical Care Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan;
Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan.
Pediatrics. 2019 Dec;144(6). doi: 10.1542/peds.2019-0748. Epub 2019 Nov 1.
Disparities in health service use have been described across a range of sociodemographic factors. Patterns of PICU use have not been thoroughly assessed.
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 ρ and analysis of variance. Analyses were event based; children admitted multiple times were counted as discrete admissions.
There were 4071 included admissions involving 3129 unique children contributing a total of 12 297 PICU bed days. Child poverty was positively associated with PICU admission rates ( = 0.59; < .001) and bed-day rates ( = 0.47; < .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 ( < .001).
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.
健康服务利用的差异在一系列社会人口因素中都有描述。儿科重症监护病房（PICU）的使用模式尚未得到全面评估。
这是一项针对 2011 年至 2016 年期间辛辛那提儿童医院医疗中心 PICU 住院患者的人群水平、回顾性分析。患者的居住地址被地理编码，并与普查区进行空间连接。如果患者居住在俄亥俄州汉密尔顿县，则符合纳入标准。使用住院人数和住院天数分别作为分子，用普查区儿童人口作为分母，计算 PICU 入院率和床位使用率。使用 Spearman's ρ 和方差分析评估 PICU 使用与儿童贫困之间的关系。分析基于事件进行；多次入院的儿童被视为单独的入院。
共有 4071 例纳入的住院患者涉及 3129 名独特的儿童，共贡献了 12297 个 PICU 床位日。儿童贫困与 PICU 入院率（ = 0.59； <.001）和床位使用率（ = 0.47； <.001）呈正相关。当根据儿童贫困率将普查区分为五分位数时，PICU 床位使用率从贫困率最低的五分位数的每 1000 名儿童 23.4 天到贫困率最高的五分位数的 81.9 天（ <.001）。
贫困与不良健康结果之间的关联包括儿科重症监护病房的使用。这种关联存在于贫困和贫困周围长大的儿童中。未来的工作应描述患者和社区层面风险因素之间的相互作用，并探索改善儿童健康的社区层面干预措施。
