Abstract 247 Poster Session III, Monday, 5/3 (poster 92)

INTRODUCTION: Socioeconomic status (SES) is a strong predictor of morbidity and mortality. In the United States, one in four children is below the federal poverty level (FPL). Children of low SES have higher morbidity from asthma and sickle cell disease, poorer immunization status, and higher incidence of hospital readmission. This study was designed to define the incidence of emergency PICU admission and to evaluate the effects of SES on these rates and severity of illness. We hypothesized that low SES children would disproportionately utilize emergency PICU care and present with a higher severity of illness.

METHODS: A population based, epidemiologic follow-up study was carried out at all five PICUs serving the DC metropolitan statistical area (MSA) over a five month period. All emergent admissions in children less that 14 years of age with a local address were included. Patient demographic data and physiologic data required to compute PRISM scores were collected by chart review. Addresses were converted to census tracts and census bureau data were used for all patient and population socio-economic data. Age adjusted PICU admission rates were compared by SES variables at two severity levels.

RESULTS: Of 1,422 admissions reviewed, 545 patients met inclusion criteria and 526 were included in this analysis. The rate of emergency PICU admission in the DC MSA for children less than 14 years of age was 6.9 per 10,000 children over the 5-month period. If we consider all children to be at risk for an emergency admission to the ICU then the incidence of emergency PICU admission in our population is 1.4/10,000 children per month or 16.6/10,000 children annually. The population of children emergently admitted to the PICU were from tracts with significantly more households below the FPL (p < 0.05) and with significantly lower median household incomes (MHHI) (p < 0.001). Admission rates were negatively correlated with MHHI. For every $10,000 increase in median household income, PICU admission rates dropped by 9% or 0.64 per 10,000 children (p = 0.00006). Chi square analysis of dichotomized SES variables revealed that impoverished children (from tracts with ≥ 10% of households below FPL) were 1.5 times more likely to be emergently admitted to the PICU (p = 0.00006). Children from census tracts with low MHHIs (< $50,000) were 1.3 times more likely to be admitted than children from tract with MHHIs above this level (p = 0.0016). The relative risk of emergent admission increased to over 2 (p = 0.000001) and 1.5 (p = 0.004 respectively, if only the higher severity (PRISM-III ≥ 5) admissions were included in the analysis.

CONCLUSION: This study shows that lower socioeconomic status, as measured by median household income and percentage of families living under the federal poverty level, is associated with an increased rate of emergency PICU admission. Further study is necessary to explore the etiology of this relationship.