Exploring the Impact of Child Opportunity on PICU Utilization and the Role of Public Insurance.

Abstract

Objectives: Public insurance reduces financial barriers to healthcare but may not fully mitigate the influence of neighborhood opportunity on pediatric critical care utilization. We examined the association between neighborhood opportunity and PICU utilization, including costs, and assessed whether public insurance modified these relationships.

Design: Population-level retrospective observational study.

Setting: A single, free-standing quaternary children's hospital in southwestern Ohio.

Patients: Children 18 years or younger admitted to the PICU between January 1, 2016, and December 31, 2022, residing within the hospital's primary service area.

Interventions: None.

Measurements and main results: Primary outcomes were census tract (CT) level PICU admission rates and median PICU costs. Very low opportunity neighborhoods had the highest PICU admission rates (3.41 vs. 1.76 admissions per 1000 children in very high opportunity neighborhoods; p < 0.001). Overall CT level median PICU costs did not differ by Child Opportunity Index (COI; p = 0.582). Publicly insured children were more likely to reside in very low opportunity neighborhoods (44% vs. 10%; p < 0.001). Within very low opportunity neighborhoods, publicly insured children had lower median PICU costs than children with other insurance ($16,693 vs. $22,585; p = 0.008); costs were similar across insurance groups in other COI quintiles. In multivariable analyses, the interaction between insurance status and neighborhood opportunity was not statistically significant (p = 0.099).

Conclusions: Children from low opportunity neighborhoods experienced higher PICU admission rates, while neighborhood opportunity and public insurance jointly influenced patterns of PICU resource utilization. Expanding insurance coverage alone is unlikely to eliminate disparities; improving neighborhood conditions and implementing place-based strategies may help mitigate PICU utilization.