(780) Child Opportunity Index and PICU Outcomes for Children With Asthma

Introduction: Neighborhood environment likely affects incidence and severity of asthma in children. We hypothesized that lower Child Opportunity Index (COI) is associated with higher severity of illness on admission and longer length of stay for children admitted to the pediatric intensive care unit (PICU) with asthma.

Methods: Demographic and clinical data for patients < 18 years of age admitted to 15 PICUs across the U.S. from 1/1/2019-12/31/2020 were compiled from sites participating in the Virtual Pediatric Systems (VPS, LLC) database. Admissions were included when Pediatric Index of Mortality 3 (PIM3) field “Asthma is the main reason for ICU admission” was selected with a consistent primary admission diagnosis. Addresses were obtained from the electronic medical record and mapped to Child Opportunity Index (COI 2.0, diversitydatakids.org) by census tract.

Results: Overall, 2172 admissions were included in 1937 unique patients. Median age at index admission was 6.6 years (IQR 3.9-10.6). Patients included 1153 (60%) males, and Race/Ethnicity was Black or African American in 1006 (52%), White in 503 (26%), Hispanic or Latino in 171 (9%), and other, mixed, or unknown in 257 (13%). COI category was very low in 906 (47%), low in 344 (18%), moderate in 302 (16%), high in 197 (10%), and very high in 188 (10%). Mean PIM3 risk of mortality was similar across COI categories (very low: 0.59%, low: 0.70%, moderate: 0.86%, high: 0.51%, very high: 0.98%, p=0.33), as was use of invasive mechanical ventilation (very low: 3%, low: 5%, moderate: 3%, high: 4%, very high: 4%, p=0.67) and CPAP/BiPap (very low: 37%; low: 34%; moderate: 39%; high: 41%; very high: 40%, p=0.41). PICU mortality was 0.5% (11/2172) and did not differ by COI category. Median PICU length of stay was highest in the high COI category (very low: 1.0 days, low: 1.2, moderate: 1.1, high: 1.3, very high: 1.2, p=0.01).

Conclusions: While clinical markers of severity and mortality did not differ between groups, nearly half of children admitted to the PICU for asthma were from very low COI neighborhoods and the majority of admissions were in Black or African American children. Future efforts should focus on interventions to eliminate these disparities in PICU usage.