1753: Child Opportunity Index Is Associated With Mortality in Critically Injured Pediatric Patients

OBJECTIVE Injury is the leading cause of death in children and adolescents. Understanding the association between social determinants of health and pediatric injury is paramount for targeted intervention. We aimed to measure the association between Child Opportunity Index (COI) 2.0 and mortality for injured patients requiring pediatric intensive care unit (PICU) admission, hypothesizing that lower COI is associated with higher mortality. METHODS This was a retrospective, multicenter study of children (aged <18 years) admitted between January 1, 2019 and December 31, 2020 to 15 US PICUs with injury, inclusive of trauma, nonaccidental injury, drowning, ingestion/poisoning, burn/inhalational injury, and suffocation. We measured the association between COI 2.0 (area-based index of social determinants of health for children) and in-hospital mortality (primary outcome) and PICU readmission (secondary outcome) using multivariable logistic regression. RESULTS We included 3778 critically injured children, of whom 235 (6.2%) died. Distribution by COI was: 29% Very Low, 19% Low, 20% Moderate, 16% High, and 16% Very High. After adjustment for age, sex, mechanism, complex chronic condition, and severity of illness, the adjusted odds of mortality were approximately 2.5 times greater for patients with Very Low (aOR 2.4 [1.02–6.05]) and Moderate COI (aOR 2.6 [1.1–6.61]) compared with Very High COI. Low and High COI were associated with nearly 3 times odds of readmission (low aOR 3.18 [1.31–8.94]; high aOR 3.01 [1.23–8.46]). CONCLUSION Very Low and Moderate COI was associated with increased mortality of critically injured children. Further investigation is needed to identify modifiable determinants of child opportunity to decrease pediatric injury.