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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 and 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 4 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 vs non-south Asian determined using two-name analysis algorithms).
Results: The incidence for south Asian children was higher than that of non-south Asian children (138 vs 95/100 000, incidence rate ratio 1.36, 95% CI 1.32 to 1.40). The age-sex standardised incidence for children admitted to paediatric intensive care ranged from 69/100 000 in the least deprived fifth of the population to 124/100 000 in the most deprived fifth. The risk-adjusted OR for mortality for south Asian children was 1.36 (95% CI 1.18 to 1.57) overall, rising to 2.40 (95% CI 1.40 to 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 for children from more deprived areas and 36% higher for children from the south Asian population. Risk-adjusted mortality increases in south Asian children as deprivation decreases.
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Footnotes
Funding: PICANet is funded by the Healthcare Quality Improvement Partnership (HQIP), Health Commission Wales Specialised Services, NHS Lothian/National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children and the Pan Thames PICU Commissioning Consortium. The views expressed are those of the authors.
Competing interests: None.
List of participating NHS Trusts and hospitals: Addenbrooke’s NHS Trust: Addenbrooke’s Hospital; Birmingham Children’s Hospital NHS Trust: Diana, Princess of Wales Children’s Hospital; Brighton and Sussex University Hospitals NHS Trust: Royal Alexandra Hospital for Sick Children; Cardiff and Vale NHS Trust: University Hospital of Wales; Central Manchester and Manchester Children’s University Hospitals NHS Trust: Royal Manchester Children’s Hospital; Great Ormond Street Hospital for Children NHS Trust: Great Ormond Street Hospital for Sick Children; Guy’s and St. Thomas’ Hospital NHS Trust: Guy’s Hospital; Hull and East Yorkshire Hospitals NHS Trust: Hull Royal Infirmary; King’s College Hospital NHS Trust: King’s College Hospital; Leeds Teaching Hospitals NHS Trust: Leeds General Infirmary, St. James’ University Hospital; Newcastle upon Tyne Hospitals NHS Trust: Newcastle General Hospital, Freeman Hospital, Royal Victoria Infirmary; Oxford Radcliffe Hospitals NHS Trust: John Radcliffe Hospital; Queen’s Medical Centre Nottingham University NHS Trust: Queen’s Medical Centre; Royal Brompton & Harefield NHS Trust: Royal Brompton Hospital; Royal Liverpool Children’s NHS Trust: Alder Hey Hospital; Sheffield Children’s NHS Trust: Sheffield Children’s Hospital; Southampton University Hospitals NHS: Trust Southampton General Hospital; South Tees Hospitals NHS Trust: James Cook University Hospital; St. George’s Healthcare NHS Trust: St. George’s Hospital; St. Mary’s NHS Trust: St. Mary’s Hospital; The Lewisham Hospitals NHS Trust: University Hospital, Lewisham.
PICANet Steering Group members: Mrs Pamela Barnes, Professor Nick Black (Chair) (2002–2007), Mr William Booth, Ms Bev Botting Child (2002–September 2003), Dr Jean Chapple (2002–2006), Dr Bill Chaudhry (2002–September 2003), Dr Mark Darowski, Mr Noel Durkin, Dr Steve Kerr, Mr Ian Langfield (2002–September 2003), Dr Michael Marsh, Dr Jillian McFadzean, Dr Roddy McFaul (2002–September 2003), Professor Jon Nicholl, Dr Gale Pearson, Ms Tanya Ralph, Ms Laura Reekie, Dr Kathy Rowan, Mr Stuart Rowe, Ms Dominique Sammut, Dr Jenifer Smith, Dr Charles Stack, Professor Stuart Tanner, Dr Robert Tasker.
PICANet Clinical Advisory Group members: Dr Paul Baines (2002–present), Ms Corenna Bowers Sister (2002–September 2004), Dr Andrew Durward (2002–present), Ms Georgina Gymer (2005–October 2006), Dr James Fraser (2002–October 2005), Dr Hilary Klonin (2002–present), Ms Christine Mackerness (2002–present), Dr Jillian McFadzean (2005–present), Ms Victoria McLaughlin, (2002–present), Dr Roddy O’Donnell (2002–present), Ms Geralyn Oldham (2002–present), Dr Gale Pearson (Chair) (2002–present), Dr Damian Pryor (2002–September 2004), Dr Allan Wardhaugh (Sept 2004–present), Ms Debbie White (2002–present).
Contributors and sources: ESD, PAM and RCP are principle investigators for PICANet. GJP is a former principle investigator. RCT is a consultant paediatric intensivist and chair of the Paediatric Intensive Care Society Study Group. KT is a co-worker in PICANet and SJ and TC former co-workers. RCP, ESD, PAM and GJP initiated the project. RCP conducted the statistical analysis and wrote the first draft. GJP provided additional statistical advice. Thereafter RCP, PAM, RCT GJP, ESD, KT, SJ and TC critically revised the manuscript. PAM is the guarantor.