Social determinants of health and intensive care unit admission rates and outcomes for children, Australia, 2013-2020: analysis of national registry data

Abstract

OBJECTIVES: To investigate the influence of non-medical social determinants of health on rates of admission and outcomes for children admitted to intensive care units (ICUs) in Australia. STUDY DESIGN: Retrospective cohort study; analysis of Australian and New Zealand Paediatric Intensive Care Registry data. SETTING, PARTICIPANTS: Children (18 years or younger) admitted to Australian ICUs during 1 January 2013 - 31 December 2020. MAIN OUTCOME MEASURES: Population-standardised ICU admission rates, overall and by residential socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD] quintile) and Indigenous status; likelihood of mortality in the ICU by residential socio-economic status (continuous, and quintile 1 v quintiles 2-5) and Indigenous status, adjusted for pre-illness, admission, and ICU and hospital factors. RESULTS: Data for 77 233 ICU admissions of children were available. The ICU admission rate for Indigenous children was 1.91 (95% confidence interval [CI], 1.87-1.94), for non-Indigenous children 1.60 (95% CI, 1.57-1.64) per 1000 children per year. The rate was higher for children living in areas in the lowest IRSD quintile (1.93; [95% CI, 1.89-1.96]) than for those living in quintile 5 (1.26 [95% CI, 1.23-1.29] per 1000 children per year). Unadjusted in-ICU mortality was higher for Indigenous than non-Indigenous children (2.5% v 2.1%) and also for children living in the lowest IRSD quintile than in quintiles 2-5 (2.5% v 2.0%). After adjustment for all factors, mortality among Indigenous children was similar to that for non-Indigenous children (adjusted odds ratio [aOR], 1.15; 95% CI, 0.92-1.43); it was higher for children living in the lowest IRSD quintile than for those living in quintiles 2-5 (aOR, 1.18; 95% CI, 1.03-1.36). Remoteness and distance between home and ICU did not influence the likelihood of death in the ICU. CONCLUSIONS: The population-standardised ICU admission rate is higher for Indigenous children and children residing in areas of greatest socio-economic disadvantage than for other children in Australia. Adjusted in-ICU mortality was higher for children from areas of greatest socio-economic disadvantage. Advancing health equity will require further investigation of the reasons for these differences.