P1.014: Determining the Effects of Social Determinants of Health on Patient Outcomes in ​Pediatric Critical Care Units​

Background: Social determinants of health (SDOH) such as economic stability, education, healthcare access, neighborhood, and social context impact overall health. The relationship between adverse SDOH and clinical outcomes is unclear. In 2021, we began screening for SDOH in our pediatric critical care units. We hypothesized that adverse SDOH would impact clinical outcomes such as initial severity of illness and length of stay (LOS).

Methods: We conducted a retrospective cohort study of children admitted to the pediatric intensive care and intermediate care units at an urban, tertiary care, teaching hospital. Adverse SDOH were assessed using a self-reported, validated tool called THRIVE. Socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) and Child Opportunity Index (COI) based on patient home addresses. Clinical outcomes included admission Pediatric Logistic Organ Dysfunction-2 (PELOD-2) (a validated severity-of-illness score) and total LOS. We also planned a subgroup analysis of children admitted with asthma exacerbations. Descriptive and regression analyses evaluated associations between SDOH, ADI, COI, and clinical outcomes.

Results: 205 patients were analyzed. 51% of patients were female, and the mean age was 7.7 years (SD 6.4). The prevalence of at least one adverse SDOH (SDOH-positive) was 34%, with the most common being education (19%) and food insecurity (18%). SDOH-positive patients had significantly higher ADI national percentile (median 62 vs 47, p < 0.001) and lower COI (2 vs 3, p = 0.009), representing increased deprivation. Mean PELOD-2 score was 1.3 (SD 2.4); median PELOD-2 score was 0 (IQR 0 to 2); median total LOS was 2.10d (IQR 1.07 to 4.85). Comparing SDOH-positive with SDOH-negative patients, there was no difference in PELOD-2 score (median 0 vs. 0) nor total LOS (median 2.14d vs 2.10d, respectively). In the asthma exacerbation subgroup (N = 21), there was no difference in clinical outcomes between SDOH-positive and SDOH-negative patients, but there was a positive correlation between ADI and initial asthma score (rho = 0.53, p = 0.01).

Conclusion: Adverse SDOH were prevalent and associated with higher deprivation and lower opportunity but did not significantly impact initial severity of illness and total LOS. Addressing needs in the community and standardizing care in the hospital can achieve health equity.