Geospatial Analysis of Neighborhood Level Social Determinants of Health in Children with Acute Respiratory Failure Requiring Mechanical Ventilation and their Causal Association with All-Cause Hospital Mortality Restricted; Files Only
Grunwell, Jocelyn (Spring 2023)
Published
Abstract
Poverty, racial bias, and disparities are linked to adverse health outcomes for children in the United States. The social vulnerability and child opportunity indices are composite measures of the social, economic, education, health, and environmental qualities that impact human health for every U.S. census tract. We performed a cross-sectional study of children admitted to pediatric intensive care units for acute respiratory failure requiring invasive mechanical ventilation at two urban free-standing children’s hospitals in Atlanta, Georgia. Residential addresses were geocoded and spatially joined to census tracts. Neighborhood hot spots were defined as census tracts where admissions were at the 90th percentile or greater per 1,000 children. We compare composite measures of social vulnerability and child opportunity by neighborhood hot spot status. We used multivariate logistic regression and mediation analysis to model whether a low child opportunity index was associated with all-cause hospital mortality. Residential addresses were geocoded and spatially joined to census tracts for 3,514 children. Composite measures of social vulnerability and child opportunity, PICU readmission rates, and hospital length of stay were compared between neighborhood hot spots (n = 340, 9.7%) versus non-hot spots. Hot spots were associated with a worse overall social vulnerability index ranking, reflecting differences in socioeconomic status, household composition and disability, and housing type and transportation. Hot spots also had a worse overall child opportunity index percentile ranking, reflecting differences in the education, health and environment, and social and economic domains. Higher social vulnerability and lower child opportunity were associated with longer total median duration of hospital days per 1000 children in a census tract. Children living in low opportunity neighborhoods had an age-adjusted odds of dying that was 1.29 (95% CI: 1.03, 1.60) times that of children in high opportunity neighborhoods with 26% of the effect mediated by hospital location. The detailed metrics of validated, ranked scores that identify opportunity gaps may inform interventions designed to increase opportunity and reduce mortality for critically ill children. Interventions that address neighborhood child opportunity are needed to decrease disparities in intensive care admissions for acute respiratory failure requiring mechanical ventilation.
Table of Contents
Chapter 1. Geospatial Analysis and the Social Determinants of Health in Pediatric Critical Illness 1
Introduction 1
Neighborhood, Population-Level versus Individual-Level Factors 4
Geospatial Visualization and Analysis Methods 5
The Area Deprivation Index 7
Other Indices of Neighborhood Material Deprivation 8
The Social Vulnerability Index 8
The Child Opportunity Index 2.0 (COI) 10
Implications of Using a Neighborhood Opportunity Index in Pediatric Critical Care Medicine 12
Study Motivation, Objectives, and Hypotheses 13
Chapter 2. Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated with Pediatric Intensive Care Use for Acute Respiratory Failure Requiring Mechanical Ventilation 15
Introduction 15
Methods 16
Study Setting and Design 16
Ethics Statement 16
Geocoding, Mapping, and Census Tract Data 16
Hot spot Identification 17
Outcome Measures 17
Statistical analyses 18
Results 18
Study population 18
Social Vulnerability Index is higher in children residing in neighborhood hot spots 22
Child Opportunity Index is lower in children residing in neighborhood hot spots 23
Outcomes 28
Discussion 29
Chapter 3. The Child Opportunity Index is Associated with Disparities in All-Cause Hospital Death of Mechanically Ventilated Children Across Georgia 36
Introduction 36
Methods 37
Study Design, Setting, and Participants 37
Ethics Statement 38
Geocoding, Mapping, and Census Tract Data 38
Variables 38
Statistical Methods 40
Mediation Analysis 41
Sensitivity and Subgroup Analyses 41
Results 42
Study Population 42
All-Cause Hospital Mortality by COI Exposure 45
Mediation Analysis 47
Sensitivity and Subgroup Analyses for All-cause Hospital Mortality by COI Exposure 48
Multivariable Analysis of Prolonged Hospitalization by COI Exposure 51
Discussion 51
Bibliography 58
About this Master's Thesis
School | |
---|---|
Department | |
Degree | |
Submission | |
Language |
|
Research Field | |
Parola chiave | |
Committee Chair / Thesis Advisor | |
Committee Members |
![Preview image embargoed](/assets/No_Preview-c99a369db0c8f31173bf3fdc06f581cabae85282e8a747dd66f99b731b54aec0.png)
Primary PDF
Thumbnail | Title | Date Uploaded | Actions |
---|---|---|---|
![]() |
File download under embargo until 22 May 2029 | 2023-04-13 12:13:35 -0400 | File download under embargo until 22 May 2029 |
Supplemental Files
Thumbnail | Title | Date Uploaded | Actions |
---|