Social Determinants of Health and Health-Related Quality of Life Following Pediatric Septic Shock: Secondary Analysis of the Life After Pediatric Sepsis Evaluation Dataset, 2014-2017.

Autor:	Lenz KB; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA., McDade J; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA., Petrozzi M; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA., Dervan LA; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA., Beckstead R; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT., Banks RK; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT., Reeder RW; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT., Meert KL; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI., Zimmerman J; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA., Killien EY; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2024 Sep 01; Vol. 25 (9), pp. 804-815. Date of Electronic Publication: 2024 Jun 05.
DOI:	10.1097/PCC.0000000000003550
Abstrakt:	Objectives: Social determinants of health (SDOH) are associated with disparities in disease severity and in-hospital outcomes among critically ill children. It is unknown whether SDOH are associated with later outcomes. We evaluated associations between SDOH measures and mortality, new functional morbidity, and health-related quality of life (HRQL) decline among children surviving septic shock. Design: Secondary analysis of the Life After Pediatric Sepsis Evaluation (LAPSE) prospective cohort study was conducted between 2014 and 2017. Setting: Twelve academic U.S. PICUs were involved in the study. Patients: Children younger than 18 years with community-acquired septic shock were involved in the study. Interventions: None. Measurements and Main Results: We assessed associations between race, ethnicity, income, education, marital status, insurance, language, and home U.S. postal code with day 28 mortality, new functional morbidity at discharge per day 28, and HRQL decline using logistic regression. Of 389 patients, 32% ( n = 98) of families had household income less than $50,000 per year. Median Pediatric Risk of Mortality (PRISM) score was 11 (interquartile range 6, 17). We found that English language and Area Deprivation Index less than 50th percentile were associated with higher PRISM scores. Mortality was 6.7% ( n = 26), new functional morbidity occurred in 21.8% ( n = 78) of patients, and HRQL decline by greater than 10% occurred in 31.0% of patients ( n = 63). We failed to identify any association between SDOH measures and mortality, new functional morbidity, or HRQL decline. We are unable to exclude the possibility that annual household income greater than or equal to $50,000 was associated with up to 81% lesser odds of mortality and, in survivors, more than three-fold greater odds of HRQL decline by greater than 10%. Conclusions: In this secondary analysis of the 2014-2017 LAPSE dataset, we failed to identify any association between SDOH measures and in-hospital or postdischarge outcomes following pediatric septic shock. This finding may be reflective of the high illness severity and single disease (sepsis) of the cohort, with contribution of clinical factors to functional and HRQL outcomes predominating over prehospital and posthospital SDOH factors. Competing Interests: This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grants R03HD104001 (Dr. Reeder) and K23HD100566 (Dr. Killien). The Life After Pediatric Sepsis Evaluation study was funded by the Eunice Kennedy Shriver NICHD grant R01HD073362, and was supported in part by the following cooperative agreements: UG1HD050096, UG1HD049981, UG1HD049983, UG1HD063108, UG1HD083171, UG1HD083166, UG1HD083170, U10HD050012, U10HD063106, and U01HD049934. Drs. Lenz, Banks, Meert, Zimmerman, and Killien received support for article research from the National Institutes of Health (NIH). Dr. Beckstead received support for article research from the NICHD. Drs. Beckstead and Banks disclosed government funding. Drs. Banks, Zimmerman, and Killien’s institutions received funding from the NICHD. Drs. Reeder and Meert’s institution received funding from the NIH. Dr. Zimmerman’s institution received funding from Immunexpress; he received funding from Elsevier Publishing. Dr. Killien received funding from Immunexpress. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu