Introduction: Unplanned readmission to the pediatric intensive care unit (PICU) is a common and costly occurrence. Neighborhood disadvantage has been linked with increased risk of readmissions to the PICU. We investigated the relationship between the recently updated Child Opportunity Index (COI 3.0) and PICU readmission risk during the first year after discharge for selected acute and chronic PICU admission diagnoses.
Methods: A multicenter, retrospective, cross-sectional study of 89,335 PICU admissions in 2023-2024 for children < 17 years of age with 1 of 13 common PICU admission diagnoses. Patients’ residential ZIP codes were used to assess the neighborhood child opportunity index (COI 3.0) (a composite measure of 44 neighborhood-level factors that impact child health; categorized into five quintiles -Very High (VH) to Very Low (VL)). We analyzed the association between COI 3.0 and 1-year PICU readmission using generalized estimating equations adjusted for demographic and health utilization risk factors. Post-discharge day at which significant variation in readmission risk for Very Low vs Very High COI areas was also determined.
Results: The 1-year PICU readmission rate was 20.4%. Significant variation in readmission rates across COI levels was observed for acute bronchiolitis, lower and upper respiratory infections, asthma, and diabetic ketoacidosis (DKA). Residence in a VL-COI vs. VH-COI area was associated with increased odds of PICU readmission for 3 of the selected conditions: pneumonia (aOR 1.25; 95%CI:1.02- 1.5), asthma (aOR 1.5; 95%CI:1.3- 1.8), and DKA (aOR 1.8; 95%CI:1.3- 2.7. Significant differences in readmission risk emerged for those residing in VL-COI versus VH-COI areas at day 76 for pneumonia, day 111 for DKA, and day 119 for asthma.
Conclusions: Neighborhood child opportunity influences the risk and timing of PICU readmission for certain conditions, and this observation extends beyond the immediate discharge period. Evaluating neighborhood factors can help identify community-level contributors to disparities in long-term outcomes of critical illness.
