Authors: Hamid George Bangura, BS; Chelsea Willie, MD; Jasmine Dowell, MD

Background: Multiple studies have shown that Social Determinants of Health (SDoH) are associated with disparities in health outcomes in children and adults admitted to intensive care units. Studies have also shown that adults disproportionately suffered from severe illnesses with COVID-19. This study investigates patient-level characteristics to determine associations between SDoH and Pediatric Intensive Care Unit (PICU) admission patterns for critically ill children with COVID-19.

Methods: Retrospective analysis of acute COVID-19-related admissions to the Children’s Wisconsin (CW) PICU between January 1, 2020, and March 31, 2022, from any Emergency Department (Direct Admission) or the CW Acute Care Ward (Indirect Admission). Exclusion criteria included patients for whom initial admission decisions were made outside the CW context. The study was deemed non-human subjects research and exempted from full IRB application. All data were retrieved from the Virtual Pediatric Systems database. Multivariable statistical analysis was completed with biostatistical support from the Clinical and Translational Science Institute of Southern Wisconsin.

Results: 215 cases of COVID-19 hospitalization met inclusion criteria for analysis. The racial composition of this cohort was 39.4% Non-Hispanic White (NHW), 36.2% Non-Hispanic Black (NHB), and 19.2% Hispanic. Neighborhood Stress Score (NSS7), a measure of socioeconomic deprivation, was the primary influencer of direct admission to the PICU after adjusting for race, sex, and severity of illness (OR 1.02, 95% CI 1.02, 1.22). Secondly, indirectly admitted NHB patients had significantly longer than expected PICU stays compared to indirectly admitted NHW patients (p=0.049).

Conclusion: Socioeconomically deprived children critically ill with COVID-19 were more likely to be directly admitted to the PICU. NHB children admitted to the General Pediatric ward prior to transferring to the PICU required longer hospitalization in the PICU than predicted for their level of illness. Taken together, these findings indicate SDoH influenced admission patterns and length of stay outcomes for children with COVID-19. Our findings are in line with current research indicating NHBs are disproportionately affected by health disparities that influence health outcomes. Our research highlights why consideration of social determinants in healthcare is important when evaluating healthcare and disease, especially for centers that provide care to minority or socioeconomically disadvantaged patients.