Epidemiology of critically ill children in England and Wales: incidence, mortality, deprivation and ethnicity

ROGER C PARSLOW ^1*, Robert Charles Tasker ², Elizabeth S Draper ³, Gareth J Parry Dr⁴, Sam Jones ⁵, Tim Chater ⁶, Krishnan Thiru ⁷ and Patricia A McKinney ⁸

¹ UNIVERSITY OF LEEDS, United Kingdom
² University of Cambridge Clinical School, United Kingdom
³ University of Leicester, United Kingdom
⁴ National Initiative for Children's Healthcare Quality (NICHQ) Cambridge, MA, United States
⁵ Clinical Research Facility, Royal Hallamshire Hospital, Sheffield, United Kingdom
⁶ University of Sheffield, United Kingdom
⁷ Great Ormond Street Hospital For Sick Children, United Kingdom
⁸ Paediatric Epidemiology Group, United Kingdom

^* To whom correspondence should be addressed. E-mail: r.c.parslow{at}leeds.ac.uk.

Accepted 4 October 2008

Abstract

Objective: The purpose of this work was to investigate the incidence rate for admission and mortality of children receiving paediatric intensive care in relation to socioeconomic status and ethnicity in England & Wales.

Design: National cohort of sequential hospital admissions.

Setting: Twenty-nine paediatric intensive care units in England and Wales. Participants All children aged under 16 years admitted to paediatric intensive care in the four years 2004-2007.

Main outcome measures: Incidence rates for admission and odds ratios (OR) for risk adjusted mortality by an area based measure of deprivation (Townsend score) and ethnic group (south Asian versus non-south Asian determined using 2 name analysis algorithms).

Results: Incidence for south Asian children was higher than that of non-south Asians (138 versus 95/100000, incidence rate ratio 1.36, 95% CI 1.32-1.40). The age-sex standardised incidence for children admitted to paediatric intensive care ranged from 69/100000 in the least deprived fifth of the population to 124/100000 in the most deprived fifth. The risk-adjusted OR for mortality for south Asian children was 1.36 (95% CI 1.18-1.57) overall, rising to 2.40 (95% CI 1.40-4.10) in the least deprived fifth of the population when a statistical interaction term for deprivation was included.

Conclusions: In England and Wales, the admission rate to paediatric intensive care is higher in children from more deprived areas and 36% higher for children from the south Asian population. Risked-adjusted mortality increases in south Asian children as deprivation decreases.