Introduction: Resource-poor neighborhoods have high ICU admission rates for pediatric critical asthma (PCA). A new definition for PCA was recently published to facilitate the study of this population. We used this new definition to evaluate the association between the Child Opportunity Index 3.0 (COI) and clinical outcomes of PCA, with the hypothesis that lower COI would be associated with worse clinical outcomes. Methods: A 6-month interim analysis of the CATCHUP study, a one-year multicenter point prevalence study of PCA in US PICUs (11/2024 to 05/2025). Subjects (age 2 to ≤ 18 years) who met the new PCA definition while admitted to general wards or PICU with either receipt of continuous albuterol or PCA adjunctive therapies were included. Screening was performed on 3-4 days of each study month. The 2024 COI 3.0 is a composite measure of 44 neighborhood-level factors that impact child health. We linked patient ZIP codes to nationally normed COI 3.0 (one of 5 quintiles: Very High (VH) to Very Low (VL)). Clinical outcomes assessed include rates of non-invasive or invasive positive pressure ventilation (PPV) use, PICU and hospital length of stay (LOS), compared across COI quintiles using chi-square and Kruskal-Wallis tests. Results: Complete data were available from 39 sites; 501 children met critical asthma criteria. PPV was used in 37% of all admissions. Median age was 6 years (IQR 4-9), with 63% on public insurance and 39% identifying as Black/African American. Children were most commonly from VL COI ZIP codes (31%) (p < 0.001), followed by low (20%), moderate (17%), high (16%), and VH (15%). PPV use by COI was similar across groups (34%, 36%, 39%, 37%, 43%, respectively; p = 0.71). There was also no significant difference in PICU (median 1.9-2.6 days across COI quintiles; p = 0.55) and hospital LOS (median 3-3.1 days across COI quintiles; p = 0.71). Conclusions: Using the new definition for PCA, children admitted to a multicenter cohort of PICUs for critical asthma were disproportionately from VL COI ZIP codes. However, illness severity as measured by PPV utilization and LOS did not differ across COI quintiles. This suggests that neighborhood factors may identify community drivers of disparities in PCA rates, and not illness severity. However, further research is needed to validate these findings.
Akande et al. (Sun,) studied this question.