Moynihan, Katie M

Russ, Vanessa

Clinch, Darren

Straney, Lahn

Millar, Johnny

Festa, Marino

Nassar, Natasha

Basu, Shreerupa

Thavarajasingam, Thavani

Long, Debbie

Secombe, Paul

Slater, Anthony J

2025-04-08

To investigate the influence of non-medical social determinants of health on rates of admission and outcomes for children admitted to intensive care units (ICUs) in Australia.Retrospective cohort study; analysis of Australian and New Zealand Paediatric Intensive Care Registry data.Children (18 years or younger) admitted to Australian ICUs during 1 January 2013 - 31 December 2020.Population-standardised ICU admission rates, overall and by residential socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD] quintile) and Indigenous status; likelihood of mortality in the ICU by residential socio-economic status (continuous, and quintile 1 v quintiles 2-5) and Indigenous status, adjusted for pre-illness, admission, and ICU and hospital factors.Data for 77 233 ICU admissions of children were available. The ICU admission rate for Indigenous children was 1.91 (95% confidence interval [CI], 1.87-1.94), for non-Indigenous children 1.60 (95% CI, 1.57-1.64) per 1000 children per year. The rate was higher for children living in areas in the lowest IRSD quintile (1.93; [95% CI, 1.89-1.96]) than for those living in quintile 5 (1.26 [95% CI, 1.23-1.29] per 1000 children per year). Unadjusted in-ICU mortality was higher for Indigenous than non-Indigenous children (2.5% v 2.1%) and also for children living in the lowest IRSD quintile than in quintiles 2-5 (2.5% v 2.0%). After adjustment for all factors, mortality among Indigenous children was similar to that for non-Indigenous children (adjusted odds ratio [aOR], 1.15; 95% CI, 0.92-1.43); it was higher for children living in the lowest IRSD quintile than for those living in quintiles 2-5 (aOR, 1.18; 95% CI, 1.03-1.36). Remoteness and distance between home and ICU did not influence the likelihood of death in the ICU.The population-standardised ICU admission rate is higher for Indigenous children and children residing in areas of greatest socio-economic disadvantage than for other children in Australia. Adjusted in-ICU mortality was higher for children from areas of greatest socio-economic disadvantage. Advancing health equity will require further investigation of the reasons for these differences.

Children's Hospital at Westmead, Sydney, NSW.

The University of Sydney, Sydney, NSW.

Harvard Medical School, Boston, United States of America.

Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, United States of America.

Centre for Health Equity, University of Melbourne, Melbourne, VIC.

Centre for Health Equity, University of Melbourne, Melbourne, VIC.

Monash University, Melbourne, VIC.

Royal Children's Hospital, Melbourne, VIC.

Children's Hospital at Westmead, Sydney, NSW.

The University of Sydney, Sydney, NSW.

New South Wales Kids ECMO Referral Service, Sydney, NSW.

New South Wales Kids ECMO Referral Service, Sydney, NSW.

Children's Hospital at Westmead, Sydney, NSW.

Sultan Idris Shah Hospital, Serdang, Malaysia.

Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD.

Queensland Children's Hospital, Brisbane, QLD, Australia.

Monash University, Melbourne, VIC.

Alice Springs Hospital, Alice Springs, NT.

Queensland Children's Hospital, Brisbane, QLD, Australia.

Med J Aust . 2025 Apr 8. doi: 10.5694/mja2.52643. Online ahead of print.

1326-5377

0000-0003-2515-2951

0000-0002-3720-9655

0000-0002-1137-0512

0000-0002-3127-1060

https://pubmed.ncbi.nlm.nih.gov/40195867/?otool=iaurydwlib

https://hdl.handle.net/10137/14237

Child mortality

Intensive care

Social determinants of health and intensive care unit admission rates and outcomes for children, Australia, 2013-2020: analysis of national registry data.

Journal Article

Publication