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.