Introduction: Ensuring representative research populations is critical to generalizability of results, yet PICU study cohorts often do not reflect those most at risk. Prior studies show social determinants of health can influence research participation. As part of a study investigating mental health symptoms post-PICU discharge, we collected demographic data, including Childhood Opportunity Index (COI) scores, on all eligible patients. We hypothesized that COI—a composite measure of neighborhood-level resources affecting child health—would be associated with enrollment. Methods: We conducted a retrospective cohort study of all eligible patients from August 2024 to July 2025. Patients were categorized as eligible, approached, consented, or declined. Demographics included age (2–5 vs. 6–21 years) and preferred language. COI scores were assigned using ZIP codes linked to the Child Opportunity Index 3.0 database (2020 census tracts), coded from 1 (very low) to 5 (very high). Bivariate analyses examined associations between patient characteristics and recruitment outcomes. Results: Of 167 eligible patients, 79 (47%) were COI 1–2 (very low/low), and 88 (53%) were COI 3–5. Overall, 79 (47%) were approached, of whom 69 (87%) consented and 10 (13%) declined. Overall, COI was not significantly associated with enrollment. There was no significant difference in COI between approached and unapproached patients (p=0.7), or in consent rates (81% for COI 1–2 vs. 93% for COI 3–5; p=0.2). Older children (6–21 years) were less likely to be approached than younger ones (26% vs. 42%; p=0.03). Spanish-speaking patients were more likely to decline participation (3/6, 50%) than English-speaking patients (7/73, 9.6%; p=0.024). Conclusions: In this single-center cohort, COI was not linked to approach or consent rates. However, older children were less likely to be approached, and Spanish-speaking families more likely to decline. These findings suggest that age and language may play a larger role in research engagement than other social determinants. Future efforts should focus on mitigating these barriers through age-appropriate recruitment and culturally and linguistically tailored strategies.
Spad et al. (Sun,) studied this question.