Area-Level Socioeconomic Disadvantage and Post-PICU Outcomes in Children With an Acquired Brain Injury: Single-Center Retrospective Cohort, 2016-2023.

Abstract

Objectives: To examine associations between measures of area-level socioeconomic disadvantage and disability outcomes in children with acquired brain injuries (ABIs) after PICU hospitalization.

Design: Retrospective cohort study.

Setting: Tertiary academic children's hospital.

Patients: Children 3-19 years old admitted to the PICU for ABI (2016-2023) who completed a post-PICU follow-up clinic visit 1-3 months after discharge.

Interventions: None.

Measurements and main results: In 455 children with ABI, median age of 10.8 years (interquartile range, 6.6-14.2 yr), we measured area-level socioeconomic disadvantage with the Child Opportunity Index (COI; higher scores equal less disadvantage) and Area Deprivation Index (ADI; higher scores equal more disadvantage) referenced to state. COI was categorized by quintile (very low to very high) and ADI was grouped into the lowest three, middle four, and highest three deciles. New disability was defined as greater than or equal to 1 point increase from baseline in Functional Status Scale total score at follow-up. New disability was present in 97 of 455 children (21.3%). New disability, low COI, and high ADI were independently associated with severity of illness. Multivariable logistic regression controlling for demographic and clinical covariates showed very high vs. very low COI was associated with 60% lesser odds of new disability at follow-up (adjusted odds ratio [aOR], 0.41; 95% CI, 0.17-0.99). We failed to identify such an association comparing the low to high ADI group (aOR, 0.59; 95% CI, 0.30-1.16), but we are unable to exclude the possibility that living in advantaged areas was associated with up to 70% lesser odds of new disability at follow-up.

Conclusions: In children with ABI, we have found that area-level socioeconomic disadvantage is associated with greater odds of post-PICU disability, when controlling for other demographic and severity of illness characteristics. Future research is needed to identify modifiable targets to reduce disparities in PICU outcomes after ABI.