Socioeconomic status
Several studies have identified an association between socioeconomic status and outcome of respiratory diseases at the PICU. Mukherjee et al. studied the characteristics of children admitted at the PICU for asthma. They found that children from deprived neighborhoods comprised most of the PICU admissions (61%); moreover, these children also had the highest proportion of deaths and received mechanical ventilation most frequently27. However, they surprisingly reported an increase in the Pediatric Index of Mortality score (PIM2)-score for children that lived in lesser deprived areas, also after adjusting for age, sex and the year27. Another study on acute respiratory failure in England and Wales also reported a higher proportion of admitted infants coming from deprived areas28. Interestingly, Swathi et al. found that all of the children that died in their study (5,9%) were born with a lower socioeconomic status (defined by the Kuppuswamy scale, which is a composite score of education and occupation of the head of the family, along with the monthly income of the family)29.
Another study also reported an independent association between socioeconomic stratum (defined by income, employment, housing and educational level) with the development of severe RSV disease and respiratory failure in infants30. This study confirmed the findings by Slain et al, who found that children with severe bronchiolitis coming from a low-income household, had a longer LOS at the PICU and an increased need for mechanical ventilation compared to children raised above poverty threshold31. Finally, another study found that having a lower median household income decreased readmission intervals for asthma, after being admitted to the PICU for severe acute asthma before32. The studies above show that there are unfavorable outcomes in patients admitted at the PICU with respiratory problems having a lower socioeconomic status. In conclusion, in acute pediatric respiratory diseases, outcomes such as mortality, LOS, mechanical ventilation and readmission interval are negatively correlated with poverty and being a minority living in a deprived area.