Association of Pediatric Critical Illness With Household Income Trajectories

Background We aimed to quantify longitudinal changes in household income among families of pediatric survivors of critical illness and to identify factors associated with catastrophic household income decline. Methods This nationwide retrospective cohort study used data from the National Health Insurance Service of South Korea. We included 10 590 pediatric patients aged 1 month to 17 years who were admitted to intensive care units (ICUs) between January 1, 2020, and December 31, 2022, and survived for at least 365 days after ICU admission. The primary outcome was the longitudinal change in household income level (ordinal scale, 0-20) between the pre-ICU baseline and the subsequent calendar-year assessment, analyzed using generalized estimating equation (GEE) models. A sensitivity analysis assessed income two calendar years after ICU admission in the 2020-2021 cohort. Results Among 10 590 pediatric survivors, 2837 (26.8%) experienced a decline in household income, and 797 (7.5%) experienced catastrophic household income decline. In the primary GEE model, household income did not significantly differ between the pre-ICU and post-ICU assessments (ratio of means [RoM], 0.99; 95% CI, 0.99-1.00; P = .631). The 2-calendar-year sensitivity analysis yielded a consistent result (RoM, 0.99; 95% CI, 0.96-1.01; P = .299). In subgroup analyses, higher-income households showed decreases in income level, including Q4 (RoM, 0.96; 95% CI, 0.95-0.97; P < .001), whereas Q1 households showed a relative increase (RoM, 2.05; 95% CI, 1.94-2.16; P < .001). Conclusions Pediatric critical illness was not associated with a statistically significant change in household income at the population level. However, subgroup analyses suggested differing patterns of income change across baseline socioeconomic strata, including declines among higher-income households. These findings highlight potential socioeconomic heterogeneity in the financial consequences experienced by families following pediatric critical illness.