There are established associations between adverse health outcomes and poverty, but little is known regarding these associations in critically ill children. We hypothesized that living in poorer communities would be associated with unfavorable outcomes in children with critical bronchiolitis. This retrospective study included children with bronchiolitis admitted to a pediatric intensive care unit (PICU) over a 2-year period. Median household income was estimated from patient ZIP codes and 2014 US Census Bureau data. The 2014 Federal Poverty Threshold (FPT) for a family of 4 was $24 008. Patients were classified as living in ZIP codes below or above the 150% FPT (150FPT). Living <150FPT was associated with longer PICU length of stay (LOS), longer hospital LOS, higher odds of needing mechanical ventilation, and increased hospital charges. In this cohort of critically ill children with bronchiolitis, living in a poorer community was associated with more unfavorable clinical outcomes.
DeNavas-WaltCProctorBD; US Census Bureau. Income and Poverty in the United States: 2013. Current Population Reports. Washington, DC: US Census Bureau; 2014.
2.
NikiémaBSpencerNSéguinL.Poverty and chronic illness in early childhood: a comparison between the United Kingdom and Quebec. Pediatrics. 2010;125:e499-e507.
3.
ShonkoffJPGarnerAS; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129:e232-e246.
4.
HogueCJHargravesMA.Class, race, and infant mortality in the United States. Am J Public Health. 1993;83:9-12.
5.
Metallinos-KatsarasEMustAGormanK.A longitudinal study of food insecurity on obesity in preschool children. J Acad Nutr Diet. 2012;112:1949-1958.
6.
ForemanMGWillsieSK.Health care disparities in critical illness. Clin Chest Med. 2006;27:473-486.
7.
SotoGJMartinGSGongMN.Healthcare disparities in critical illness. Crit Care Med. 2013;41:2784-2793.
8.
WilliamsDRCollinsC.Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116:404-416.
9.
WilliamsDRSternthalM.Understanding racial-ethnic disparities in health: sociological contributions. J Health Soc Behav. 2010;51(suppl):S15-S27.
10.
KimCRouxAVDHoferTPNallamothuBKBernsteinSJRogersMA.Area socioeconomic status and mortality after coronary artery bypass graft surgery: the role of hospital volume. Am Heart J. 2007;154:385-390.
11.
RaoSVSchulmanKACurtisLHGershBJJollisJG.Socioeconomic status and outcome following acute myocardial infarction in elderly patients. Arch Intern Med. 2004;164:1128-1133.
12.
PierceHCMansbachJMFisherESet al. Variability of intensive care management for children with bronchiolitis. Hosp Pediatr. 2015;5:175-184.
13.
WangEELawBJStephensD.Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr. 1995;126:212-219.
14.
HasegawaKTsugawaYBrownDFMansbachJMCamargoCAJr.Trends in bronchiolitis hospitalizations in the United States, 2000-2009. Pediatrics. 2013;132:28-36.
15.
GuptaPBeamBWRettigantiM.Temporal trends of respiratory syncytial virus-associated hospital and ICU admissions across the United States. Pediatr Crit Care Med. 2016;17:e343-e351.
16.
FranklinJAAndersonEJWuXAmbroseCSSimõesEA.Insurance status and the risk of severe respiratory syncytial virus disease in United States preterm infants born at 32-35 weeks gestational age. Open Forum Infect Dis. 2016;3:ofw163.
17.
SangaréLCurtisMPAhmadS.Hospitalization for respiratory syncytial virus among California infants: disparities related to race, insurance, and geography. J Pediatr. 2006;149:373-377.
18.
SimoesEA.Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. J Pediatr. 2003;143(5, suppl):S118-S126.
19.
LodaFAClydeWAJrGlezenWPSeniorRJSheafferCIDennyFW.Studies on the role of viruses, bacteria, and M pneumoniae as causes of lower respiratory tract infections in children. J Pediatr. 1968;72:161-176.
20.
GlezenWPParedesAAllisonJETaberLHFrankAL.Risk of respiratory syncytial virus infection for infants from low-income families in relationship to age, sex, ethnic group, and maternal antibody level. J Pediatr. 1981;98:708-715.
21.
McConnochieKMRoghmannKJLiptakGS.Hospitalization for lower respiratory tract illness in infants: variation in rates among counties in New York state and areas within Monroe county. J Pediatr. 1995;126:220-229.
22.
BeckAFFlorinTACampanellaSShahSS.Geographic variation in hospitalization for lower respiratory tract infections across one county. JAMA Pediatr. 2015;169:846-854.
23.
World Health Organization. The Prevention of Perinatal Morbidity and Mortality: Report of a Seminar, Tours, 22-26 April 1969. Geneva, Switzerland: World Health Organization; 1972.
24.
World Health Organization. WHO Child Growth Standards: Methods and Development. Geneva, Switzerland: World Health Organization; 2006.
25.
United States Census Bureau. American Community Survey: 2014 ACS 1-Year Estimates. Suitland, MD: United States Census Bureau; 2014.
LopezAMTilfordJMAnandKJet al. Variation in pediatric intensive care therapies and outcomes by race, gender, and insurance status. Pediatr Crit Care Med. 2006;7:2-6.
28.
EpsteinDWongCFKhemaniRGet al. Race/ethnicity is not associated with mortality in the PICU. Pediatrics. 2011;127:e588-e597.
29.
ColvinJDZanilettiIFieldstonESet al. Socioeconomic status and in-hospital pediatric mortality. Pediatrics. 2013;131:e182-e190.
30.
EpsteinDReibelMUngerJBet al. The effect of neighborhood and individual characteristics on pediatric critical illness. J Community Health. 2014;39:753-759.
31.
WilliamsDRSternthalMWrightRJ.Social determinants: taking the social context of asthma seriously. Pediatrics. 2009;123(suppl 3):S174-S184.
32.
FieldstonESZanilettiIHallMet al. Community household income and resource utilization for common inpatient pediatric conditions. Pediatrics. 2013;132:e1592-e1601.
33.
WoodD.Effect of child and family poverty on child health in the United States. Pediatrics. 2003;112(3, part 2):707-711.
34.
PascoeJMWoodDLDuffeeJHKuoA; Committee on Psychosocial Aspects of Child and Family Health; Council on Community Pediatrics. Mediators and adverse effects of child poverty in the United States [published online May12, 2016]. Pediatrics. doi:10.1542/peds.2016-0340
35.
BerryJGToomeySLZaslavskyAMet al. Pediatric readmission prevalence and variability across hospitals. JAMA. 2013;309:372-380.
36.
HernandezAFCurtisLH.Minding the gap between efforts to reduce readmissions and disparities. JAMA. 2011;305:715-716.
37.
JoyntKEOravEJJhaAK.Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA. 2011;305:675-681.
38.
FisherEBStrunkRCSussmanLKSykesRKWalkerMS.Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: the Neighborhood Asthma Coalition. Pediatrics. 2004;114:116-123.
39.
SehgalAR.Impact of quality improvement efforts on race and sex disparities in hemodialysis. JAMA. 2003;289:996-1000.
40.
ChinMHAlexander-YoungMBurnetDL.Health care quality-improvement approaches to reducing child health disparities. Pediatrics. 2009;124(suppl 3):S224-S236.
41.
ShayDKHolmanRCNewmanRDLiuLLStoutJWAndersonLJ.Bronchiolitis-associated hospitalizations among US children, 1980-1996. JAMA. 1999;282:1440-1446.
42.
KriegerNWilliamsDRMossNE.Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341-378.
