Divison of Pediatric Critical Care Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA.
Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
Pediatr Res. 2023 Aug;94(2):837-844. doi: 10.1038/s41390-023-02500-w. Epub 2023 Feb 17.
Health disparities surrounding pediatric severe sepsis outcomes remains unclear. We aimed to measure the relationship between indicators of socioeconomic status and mortality, hospital length of stay (LOS), and readmission rates among children hospitalized with severe sepsis.
Children 0-18 years old, hospitalized with severe sepsis in the Nationwide Readmissions Database (2016-2018) were included. The primary exposure was median household income by ZIP Code of residence, divided into quartiles.
We identified 15,214 index pediatric severe sepsis hospitalizations. There was no difference in hospital mortality rate or readmission rate across income quartiles. Among survivors, patients in Q1 (lowest income) had a 2 day longer LOS compared to those in Q4 (Median 10 days [IQR 4-21] vs 8 days [IQR 4-18]; p < 0.0001). However, there was no difference after adjusting for multiple covariates.
Children living in Q1 had a 2 day longer LOS versus their peers in Q4. This was not significant on multivariable analysis, suggesting income quartile is not driving this difference. As pediatric severe sepsis remains an important source of morbidity and mortality in critically ill children, more sensitive metrics of socioeconomic status may better elucidate any disparities.
Children with severe sepsis living in the lowest income ZIP Codes may have longer hospital stays compared to peers in higher income communities. More precise metrics of socioeconomic status are needed to better understand health disparities in pediatric severe sepsis.
儿科严重脓毒症结局的健康差异仍不清楚。我们旨在衡量社会经济地位指标与死亡率、住院时间（LOS）和儿童严重脓毒症住院患者再入院率之间的关系。
纳入 2016-2018 年全国再入院数据库中 0-18 岁因严重脓毒症住院的儿童。主要暴露因素是按居住邮政编码划分的中位数家庭收入四分位区间。
我们确定了 15214 例索引儿科严重脓毒症住院患者。收入四分位区间的住院死亡率或再入院率无差异。在幸存者中，Q1（最低收入）患者的 LOS 比 Q4（中位数 10 天 [IQR 4-21]）长 2 天，而 Q4（中位数 8 天 [IQR 4-18]）（p<0.0001）。然而，在调整了多个协变量后，这没有差异。
与 Q4 的同龄人相比，居住在 Q1 的儿童的 LOS 长 2 天。这在多变量分析中并不显著，表明收入四分位区间并没有导致这种差异。由于儿科严重脓毒症仍然是危重症儿童发病率和死亡率的重要原因，因此更敏感的社会经济地位指标可能更好地阐明任何差异。
与收入较高社区的同龄人相比，居住在收入最低邮政编码地区的严重脓毒症儿童的住院时间可能更长。需要更精确的社会经济地位衡量标准来更好地了解儿科严重脓毒症的健康差异。
