(782) The Impact of Socioeconomic Factors on Bronchiolitis Severity and Management in the PICU

Introduction: Social Determinants of Health (SDOH) have been shown to significantly impact patient outcomes, but this relationship has been inadequately studied in the PICU. The Childhood Opportunity Index (COI) is a composite measure to estimate a child’s cumulative SDOH and are grouped into categories called Childhood Opportunity Levels (COL). In this study, we aimed to delineate the impact of SDOH on severity of bronchiolitis and illness course.

Methods: A retrospective cohort chart review of patients under two years old admitted to the PICU with Acute Respiratory Failure due to bronchiolitis was performed. The patients’ COI and COL were identified using their home zip code and the COI 2.0 index data set.

Results: 99 children were included. The incidence of patients in the very low, low, moderate, high, and very high COL categories was 21.21%, 8.08%, 17.17%, 23.23%, and 30.30%, respectively. Patients were grouped into 3 groups: those with low COL (patients with low and very low COL), moderate COL, and high COL (patients with high and very high COL). Those with moderate COL had significantly lower S/F ratio than their low and high COL counterparts (p=0.034). Most patients were on High Flow Nasal Cannula (HFNC) at PICU admission. Of those patients, there were more patients in the nationally normed high COL group than low or moderate COL group (p=0.001). When using metro-normed COL however, there were more patients in the low COL group on HFNC at admission than the moderate or high COL groups (p < 0.001). There were more patients with high nationally normed COL that required HFNC as their highest level of respiratory support than other groups (p=0.001). However, based on metro-normed COL, there were more patients with low COL than their moderate or high COL counterparts (p < 0.001). Lastly, more patients with a lower COI (0-40) were on HFNC at admission compared to higher COI (p=0.001).

Conclusions: Amongst patients admitted to the PICU with bronchiolitis, the nationally normed and metro-normed COL categories had inconsistent results. As metro-normed COL captures more inequalities within a metro region, our patients with low COL may be inadequately represented if using different normed COL categories. Further research is required to explore the impact of these differences on illness severity and course.