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Background: There is a lack of nationwide studies on health disparity of critically ill patients under the National Health Insurance (NHI) System. We aim to evaluate health disparities in intensive care unit (ICU) admission, outcomes, and readmission after ICU discharge in an impoverished pediatric population.Methods: We conducted a retrospective cohort study using a national database of claims submitted to the Korean NHI and Medical Aid Program (MAP). MAP provides support for the population whose household income is lower than 40% of the median Korean household income, and we defined poverty as being a MAP beneficiary. Patients between 28 days and 18 years old who were admitted to the ICU between August 1, 2010 and September 30, 2013, were included. Demographic characteristics, procedures, admission rates, and clinical outcomes were compared between the poverty and reference groups. Logistic regression model used to analyze hospital mortality and readmission with adjustment for patient characteristics, hospital type, and management procedures.Results: Out of 17,893 patients, 1,153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There were more deaths among impoverished patients who were admitted to the ICU (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group had a similar risk of adjusted in-hospital mortality to those not in the poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84–1.55) but a higher readmission rate (hazard ratio 1.25, CI 1.09–1.42).Conclusion: Pediatric patients in poverty were more likely to die in association with ICU admission. A high ICU admission rate rather than the high in-hospital mortality rate may cause the disparity in deaths. Further policies and studies are required to improve the health status of pediatric patients in poverty to decrease ICU admission.Trial registration: retrospectively registered |
