■有新的证据表明,健康的社会和环境决定因素对儿科重症监护病房(PICU)的入院和结果的影响。我们分析了英国儿科重症监护数据,以根据儿童的种族以及儿童居住区的剥夺和污染程度来探索入院发生率的差异。
■从儿科重症监护审核网络(PICANET)数据库中提取了2008年1月1日至2021年12月31日期间英国PICU收治的16岁以下儿童的数据。种族被归类为白人,亚洲人,黑色,混合或其他。使用“低收入家庭中的儿童”措施对剥夺进行了量化,并使用地方当局一级的年平均PM2.5水平对室外空气污染进行了表征,两者都分为人口加权五分位数。英国人口估计值用于计算PICU入院的粗发生率。使用泊松回归模型计算发病率比率。
■有245,099人入学,其中60.7%是计划外的。在调整了年龄和性别后,与白人相比,亚洲和黑人儿童的计划外PICU相对发生率更高(IRR分别为1.29[95%CI:1.25-1.33]和1.50[95%CI:1.44-1.56]),但没有证据表明计划入院的发生率增加.生活在最贫困的五分之一的儿童的入院发生率是最贫困的五分之一的1.50倍(95%CI:1.46-1.54)。与最低的儿童相比,生活在污染最严重的五分之一人口中的儿童的原始入学水平更高(每100,000个儿童年龄为157.8对113.6个),但在种族调整后,剥夺,年龄和性别在污染和PICU入院之间没有相关性(IRR1.00[95%CI:1.00-1.00]每增加1μg/m3).
■种族和剥夺会影响PICU入院的发生率。当仅限制计划外呼吸入院和通气患者时,污染水平升高与PICU入院发生率增加相关.必须采取行动减少这些观察到的差异,需要进一步的工作来了解这些发现背后的机制以及它们与结果的关系.
■这个项目没有直接资助。HM由NIHR学术临床奖学金(ACF-2022-18-017)资助。
UNASSIGNED: There is emerging evidence on the impact of social and environmental determinants of health on paediatric intensive care unit (PICU) admissions and outcomes. We analysed UK paediatric intensive care data to explore disparities in the incidence of admission according to a child\'s ethnicity and the degree of deprivation and pollution in the child\'s residential area.
UNASSIGNED: Data were extracted on children <16 years admitted to UK PICUs between 1st January 2008 and 31st December 2021 from the Paediatric Intensive Care Audit Network (PICANet) database. Ethnicity was categorised as White, Asian, Black, Mixed or Other. Deprivation was quantified using the \'children in low-income families\' measure and outdoor air pollution was characterised using mean annual PM2.5 level at local authority level, both divided into population-weighted quintiles. UK population estimates were used to calculate crude incidence of PICU admission. Incidence rate ratios were calculated using Poisson regression models.
UNASSIGNED: There were 245,099 admissions, of which 60.7% were unplanned. After adjusting for age and sex, Asian and Black children had higher relative incidence of unplanned PICU admission compared to White (IRR 1.29 [95% CI: 1.25-1.33] and 1.50 [95% CI: 1.44-1.56] respectively), but there was no evidence of increased incidence of planned admission. Children living in the most deprived quintile had 1.50 times the incidence of admission in the least deprived quintile (95% CI: 1.46-1.54). There were higher crude admission levels of children living in the most polluted quintile compared to the least (157.8 vs 113.6 admissions per 100,000 child years), but after adjustment for ethnicity, deprivation, age and sex there was no association between pollution and PICU admission (IRR 1.00 [95% CI: 1.00-1.00] per 1 μg/m3 increase).
UNASSIGNED: Ethnicity and deprivation impact the incidence of PICU admission. When restricting to unplanned respiratory admissions and ventilated patients only, increasing pollution level was associated with increased incidence of PICU admission. It is essential to act to reduce these observed disparities, further work is needed to understand mechanisms behind these findings and how they relate to outcomes.
UNASSIGNED: There was no direct funding for this project. HM was funded by an NIHR Academic Clinical Fellowship (ACF-2022-18-017).