Key result
Poverty in critically ill children is linked to ~25% more readmissions despite no mortality difference.
Why the study?
Nationwide studies evaluating health disparities among critically ill patients under the National Health Insurance system were lacking.
Does poverty increase mortality and readmission in critically ill children admitted to the ICU?
Cohort (n=17,893)
Yes
Does poverty increase mortality and readmission in critically ill children admitted to the ICU?
Effect estimate: OR 1.15 (95% CI 0.84-1.55)
Absolute Event Rate: 6% vs 5.1%
p-value: p=0.384
In a Korean nationwide cohort, impoverished critically ill children had similar adjusted in-hospital mortality but higher rates of readmission and emergency room visits within 3 months of discharge compared to non-impoverished children.
Poverty associated with higher pediatric ICU readmission but not mortality; leaves open causal mechanisms and intervention targets.
BACKGROUND: There is a lack of nationwide studies on critically ill patients' health disparity under the National Health Insurance (NHI) system. We evaluated health disparities in intensive care unit (ICU) admission, outcomes, and readmission in impoverished children. METHODS: We conducted a retrospective cohort study using a national database from the Korean NHI and Medical Aid Program (MAP). MAP supports the population whose household income is lower than 40% of the median Korean household income. We defined poverty as being a MAP beneficiary and compared the poverty and non-poverty groups. Patients between 28 days and 18 years old who were admitted to the ICU were included. Hospital mortality and readmission were analyzed with adjustment for patient characteristics, hospital type, and management procedures. RESULTS: Out of 17,893 patients, 1153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There was more age-standardized mortality in the poverty group (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group did not have a statistically different risk of adjusted in-hospital mortality to those in the non-poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84-1.55) but had a higher readmission rate (hazard ratio 1.25, CI 1.09-1.42). CONCLUSION: Under the NHI system, the disparity in pediatric critical care outcomes according to poverty is not definite, but the healthcare disparity in pre- and post-hospital care is a concern. Further studies are required to improve pre- and post-hospital healthcare quality of impoverished children.
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Park et al. (2021) conducted a cohort in Critically ill children requiring intensive care (n=17,893). Poverty (Medical Aid Program beneficiary) vs. Non-poverty (National Health Insurance) was evaluated on In-hospital mortality (OR 1.15, 95% CI 0.84-1.55, p=0.384). Critically ill children in poverty did not have a significantly different risk of adjusted in-hospital mortality compared to those not in poverty (OR 1.15), but had a higher readmission rate (HR 1.25).
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