Departments of Cardiology.
Departments of Pediatrics.
Pediatrics. 2023 Dec 1;152(6). doi: 10.1542/peds.2023-061305.
Relationships between social drivers of health (SDoH) and pediatric health outcomes are highly complex with substantial inconsistencies in studies examining SDoH and extracorporeal membrane oxygenation (ECMO) outcomes. To add to this literature with emerging novel SDoH measures, and to address calls for institutional accountability, we examined associations between SDoH and pediatric ECMO outcomes.
This single-center retrospective cohort study included children (<18 years) supported on ECMO (2012-2021). SDoH included Child Opportunity Index (COI), race, ethnicity, payer, interpreter requirement, urbanicity, and travel-time to hospital. COI is a multidimensional estimation of SDoH incorporating traditional (eg, income) and novel (eg, healthy food access) neighborhood attributes ([range 0-100] higher indicates healthier child development). Outcomes included in-hospital mortality, ECMO run duration, and length of stay (LOS).
540 children on ECMO (96%) had a calculable COI. In-hospital mortality was 44% with median run duration of 125 hours and ICU LOS 29 days. Overall, 334 (62%) had cardiac disease, 92 (17%) neonatal respiratory failure, 93 (17%) pediatric respiratory failure, and 21 (4%) sepsis. Median COI was 64 (interquartile range 32-81), 323 (60%) had public insurance, 174 (34%) were from underrepresented racial groups, 57 (11%) required interpreters, 270 (54%) had urban residence, and median travel-time was 89 minutes. SDoH including COI were not statistically associated with outcomes in univariate or multivariate analysis.
We observed no significant difference in pediatric ECMO outcomes according to SDoH. Further research is warranted to better understand drivers of inequitable health outcomes in children, and potential protective mechanisms.
社会驱动因素（SDoH）与儿科健康结果之间的关系非常复杂，在研究 SDoH 与体外膜氧合（ECMO）结果时存在大量不一致的情况。为了在新兴的新型 SDoH 措施方面增加这方面的文献，并回应对机构问责制的呼吁，我们研究了 SDoH 与儿科 ECMO 结果之间的关联。
这项单中心回顾性队列研究纳入了接受 ECMO 支持的儿童（<18 岁）（2012-2021 年）。SDoH 包括儿童机会指数（COI）、种族、民族、支付方、口译员需求、城市化程度和到医院的旅行时间。COI 是对 SDoH 的多维估计，其中包括传统（例如收入）和新颖（例如健康食品获取）的邻里属性（[范围 0-100]越高表示儿童发育越健康）。纳入的结局包括院内死亡率、ECMO 运行时间和住院时间（LOS）。
540 名接受 ECMO 的儿童（96%）有可计算的 COI。院内死亡率为 44%，中位运行时间为 125 小时，ICU LOS 为 29 天。总体而言，334 名（62%）患有心脏病，92 名（17%）患有新生儿呼吸衰竭，93 名（17%）患有儿科呼吸衰竭，21 名（4%）患有败血症。COI 的中位数为 64（四分位距 32-81），323 名（60%）有公共保险，174 名（34%）来自代表性不足的种族群体，57 名（11%）需要口译员，270 名（54%）居住在城市，中位旅行时间为 89 分钟。SDoH 包括 COI，在单变量和多变量分析中均与结局无统计学关联。
我们观察到，根据 SDoH，儿科 ECMO 结局没有显著差异。需要进一步研究，以更好地了解儿童健康结果不平等的驱动因素和潜在的保护机制。
