Mitchell Hannah K, Seaton Sarah E, Mustafa Khurram, Jones Gareth A L, Buckley Hannah, Davis Peter, Leahy Christopher, Feltbower Richard G, Ramnarayan Padmanabhan
Institute of Child Health, University College London, London, UK; Section of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
Department of Population Health Sciences, University of Leicester, Leicester, UK; PICANet, Child Health Outcomes Research at Leeds (CHORAL), Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK.
Lancet Child Adolesc Health. 2025 Sep;9(9):646-654. doi: 10.1016/S2352-4642(25)00156-7. Epub 2025 Jul 10.
Evidence from UK paediatric intensive care units (PICUs) demonstrates increased incidence of admission among children of Asian and Black ethnicity and children residing in more deprived areas. We aimed to investigate whether mortality in PICU is associated with ethnicity and child poverty.
This national cohort study included children aged 0-15 years who were admitted to PICUs in the UK between Jan 1, 2008, and Dec 31, 2021. Participating PICUs were affiliated with and reported outcome data to the Paediatric Intensive Care Audit Network (PICANet), from which we extracted data for this analysis. Key exposures were ethnicity, categorised as Asian, Black, Multiple, Other, and White, and area-level deprivation at the time of admission, quantified with the Children in Low-Income Families measure of an area's proportion of children living in families with income less than 60% of the median income and receiving out-of-work benefits or tax credits. The primary outcome was mortality during PICU stay. Mixed-effects logistic regression clustered by admitting PICU centre and individual patient was used to examine the association between key exposures and mortality during PICU stay for all admissions and then separately for planned and unplanned admissions.
This analysis included 245 099 admissions for 163 163 children during the study period, during which 102 990 (63·1%) had unplanned PICU admissions. 15 017 (9·2%) admissions were for children of Asian ethnicity, 7244 (4·4%) for children of Black ethnicity, 4514 (2·8%) for children of multiple ethnicities, 3831 (2·4%) for children of other ethnicities, and 100 241 (61·4%) for children of White ethnicity. Ethnicity data were missing for 32 316 (19·8%) of admissions. Observed PICU mortality across planned and unplanned admissions was 3·7% (9056 deaths per 245 099 admissions). Crude PICU mortality was highest among Asian children (1336 [5·1%; 95% CI 4·9-5·5] deaths per 26 022 admissions) and lowest among White children (4960 [3·2%; 3·1-3·3] deaths per 154 041 admissions), indicating a higher relative odds of PICU mortality among Asian children than White children for all admission types (odds ratio [OR] 1·52 [95% CI 1·42-1·62]). Odds of PICU mortality did not differ between children of Black and White ethnicity (OR 1·04; 95% CI 0·93-1·15). Children of multiple ethnicities (OR 1·23 [95% CI 1·08-1·39]) and other ethnicities (1·20 [1·05-1·38]) showed increased odds of PICU mortality relative to White children. PICU mortality ranged from 1025 (3·1%; 95% CI 2·9-3·3) deaths per 33 331 admissions for children in the least deprived quintile to 2432 (4·2%; 4·0-4·4) deaths per 58 110 admissions among children in the most deprived quintile, demonstrating an association between PICU mortality and area-level child poverty (OR 1·13 [95% CI 1·03-1·23]).
Variation in PICU mortality by ethnicity and area-level deprivation highlights the importance of further investigation into systemic drivers of disparities in PICU outcomes in the UK. Targeted strategies to mitigate drivers of inequalities are essential.
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来自英国儿科重症监护病房（PICUs）的证据表明，亚洲和黑人族裔儿童以及居住在贫困地区的儿童入院率有所上升。我们旨在调查儿科重症监护病房的死亡率是否与种族和儿童贫困相关。
这项全国队列研究纳入了2008年1月1日至2021年12月31日期间在英国儿科重症监护病房住院的0至15岁儿童。参与研究的儿科重症监护病房隶属于儿科重症监护审计网络（PICANet）并向其报告结果数据，我们从中提取数据进行此分析。主要暴露因素为种族，分为亚洲、黑人、多种族、其他和白人，以及入院时的地区贫困程度，用低收入家庭儿童指标来量化，即一个地区生活在收入低于中位数收入60%且领取失业福利或税收抵免家庭中的儿童比例。主要结局是儿科重症监护病房住院期间的死亡率。采用按收治儿科重症监护病房中心和个体患者聚类的混合效应逻辑回归，来检验主要暴露因素与所有入院患者以及计划内和非计划内入院患者在儿科重症监护病房住院期间死亡率之间的关联。
本分析包括研究期间163163名儿童的245099次入院，其中102990次（63.1%）为非计划内儿科重症监护病房入院。亚洲族裔儿童入院15017次（9.2%），黑人族裔儿童入院7244次（4.4%），多种族儿童入院4514次（2.8%），其他族裔儿童入院3831次（2.4%），白族裔儿童入院100241次（61.4%）。32316次（19.8%）入院的种族数据缺失。计划内和非计划内入院的儿科重症监护病房观察到的死亡率为3.7%（每245099次入院中有9056例死亡）。儿科重症监护病房的粗死亡率在亚洲儿童中最高（每26022次入院中有1336例[5.1%；95%CI 4.9 - 5.5]死亡），在白人儿童中最低（每154041次入院中有4960例[3.2%；3.1 - 3.3]死亡），这表明所有入院类型中，亚洲儿童的儿科重症监护病房死亡率相对白人儿童的可能性更高（优势比[OR]1.52[95%CI 1.42 - 1.62]）。黑人和白人族裔儿童的儿科重症监护病房死亡率可能性无差异（OR 1.04；95%CI 0.93 - 1.15）。多种族儿童（OR 1.23[95%CI 1.08 - 1.39]）和其他族裔儿童（1.20[1.05 - 1.38]）相对于白人儿童，儿科重症监护病房死亡率的可能性增加。儿科重症监护病房死亡率从最不贫困五分位数儿童的每33331次入院中有1025例（3.1%；95%CI 2.9 - 3.3）死亡，到最贫困五分位数儿童的每58110次入院中有2432例（4.2%；4.0 - 4.4）死亡，表明儿科重症监护病房死亡率与地区儿童贫困程度之间存在关联（OR 1.13[95%CI 1.03 - 1.23]）。
儿科重症监护病房死亡率因种族和地区贫困程度而异，凸显了进一步调查英国儿科重症监护病房结局差异的系统性驱动因素的重要性。针对性的策略来减轻不平等驱动因素至关重要。
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