Characterizing Health Disparities in Rehabilitation for Critically Ill Children

Introduction: Pediatric intensive care unit (PICU) survivorship has resulted in increased morbidity and rehabilitation needs to aide in return to functional baseline. Health disparities can lead to inequitable distribution of resources, creating inequality in recovery from illness. Our objective was to characterize health disparities for children requiring rehabilitation admitted to a tertiary care PICU.


Methods: This is a mixed-methods prospective cohort study. Data collection included self-reported demographic information, clinical data via chart review, therapy data via chart review, and functional status assessment via caregiver report. Geographic disparity indices such as child opportunity index (COI), social vulnerability index, and area deprivation index were extrapolated via patient address. Descriptive and regression modeling statistical techniques assessed for association between rehabilitation outcomes and social determinants of health.


Results: 50 children, ages 6 months to 21 years, with median length of stay of 20 days [IQR 8,40] have been enrolled. Fifty percent (25/50) children identified as ciswomen with one identifying as a transman. Majority patients were either Non-Hispanic White (44%), Non-Hispanic Black (40%), or Hispanic (14%). Fourteen percent were Spanish speaking. Most (56%) had public insurance. Twenty (40%) children were from very low or low opportunity neighborhoods with high social vulnerability. Twenty (40%) of the children were previously healthy. Public insurance was associated with worse mobility score in the first three days of being in the PICU, after adjusting for caregiver income and COI (p = 0.03), as well as with longer overall hospital length of stay. Subacute rehabilitation was recommended more often for Non-Hispanic White children after controlling for illness severity and insurance (p = 0.02). Children with chronic disability were more likely to need multiple forms of insurance to supplement their home care needs and were less likely to receive intensive rehabilitation while hospitalized.


Conclusions: Insurance status, race and ethnicity, and chronic medical complexity are significant social determinants affecting rehabilitation outcomes and access. Tailored interventions should focus here to improve health care for children suffering from critical illness.