Social drivers of health affect severity of asthma in children, but any association with outcomes in children with critical asthma is unknown. Retrospective cohort study of children 2-17 years old admitted to 15 United States PICUs for asthma from 2019 to 2020. Child Opportunity Index (COI) was assigned by census tract. Primary outcome was use of positive pressure ventilation (PPV), including invasive mechanical ventilation or non-invasive continuous or bilevel support. A total of 2093 admissions in 1926 patients were included; median age was 6.9 years (IQR 4.3-10.8). Patients were often from very low COI neighborhoods (46.7%), a higher percentage than in children admitted to participating PICUs concurrently for other respiratory (28.2% very low COI) or non-respiratory causes (24.8%) (p < 0.0001 for each comparison). PICU mortality was low (0.57%), with no difference by COI category. Median PICU length of stay was within 8.5 h across COI categories (1.0-1.4 days). PPV was used in 39% of admissions. Multivariable analysis revealed no association of COI category with use of PPV; older age, commercial insurance, and origin of admission were associated with PPV use. PICU readmission for asthma during a subsequent hospitalization occurred in 7.1% patients during the study period, with a stepwise decrease as COI category increased very low 8.9%; low 7.4%; moderate 5.0%; high 4.4%; very high 3.8%, p = 0.02. Children admitted to 15 PICUs for asthma were disproportionately from very low COI neighborhoods. Mortality and use of PPV were not significantly associated with COI; however, PICU readmission was significantly associated with lower COI.
McCrory et al. (Mon,) studied this question.