P3.172: Socioeconomic Inequities and Outcomes in Critically Ill Children with Sepsis: A Retrospective Study Using the Area Deprivation Index

Background: It is known that outcomes for critically ill children with sepsis are driven by early clinical intervention and immune factors; however, the impact of community-level socioeconomic disadvantage remains understudied. This analysis aims to determine whether a higher Area Deprivation Index (ADI), a validated measure of disadvantage at the exposome level, state decile is associated with clinical and functional outcomes.

Methods: The retrospective cohort study included children (1 month-18 years) admitted to the Ochsner LSU Health Shreveport PICU with suspected or confirmed sepsis, as defined by Hector Wong’s PERSEVERE Model. Non-infectious causes of elevated procalcitonin or inflammation were excluded. Chart review was used to determine enrollment status and data was subsequently entered into REDCap. Data verification was performed by two independent research assistants. Statistical analysis in Jamovi (v2.6.44) included Chi-squared tests and Relative Risk (RR) calculations to evaluate associations between ADI and length of PICU stay (LOPS). Additional variables studied included functional and clinical outcome measures, such as Pediatric Overall Performance Category (POPC) and Multiple Organ Dysfunction Score (MODS), respectively. Demographic information, culture status, history of prior sepsis, and number of comorbidities were also analyzed.

Results: Statistically significant associations were observed in children with an ADI ≥7 and LOPS ≥9 (p=0.031, Figure 1). In black or African Americans (AA) with an ADI ≥7 and LOPS ≥9, this statistically significant association persisted (p=0.04, Figure 1); such associations were not observed in white (p=0.706, Figure 1) or other races (p=0.348, Figure 1). To better understand the etiology of racial and socioeconomic status (SES) differences in LOPS, additional variables were investigated and stratified by race and ADI. However, no statistically significant associations were observed in culture status, recurrent sepsis, POPC, admission and discharge MODS, or number of comorbidities among white, black, and other races with an ADI ≥7. Data collected regarding frequencies of ADI, gender, race, LOPS, culture status, recurrent sepsis status, POPC scores, admission MODS scores, discharge MODS scores, and number of comorbidities are presented in Table 1. The mean state-level ADI was 7.55±2.6 on a scale of 1-10, indicating a high level of SES disadvantage in the study population (n=179). The mean number of comorbidities was 2.8±2.56 (n=112).

Conclusion: A significant association was established between higher ADI and longer LOPS, particularly among critically ill black or AA children. Other outcome measures, such as POPC and MODS, as well as potential confounding variables studied, such as comorbidities, did not reveal statistically significant associations. Further investigation is warranted, specifically in socioeconomically disadvantaged black or AA children, to expound upon factors contributing to higher-than average LOPS and highlight opportunities for community interventions to reduce health inequities.