PICU Mortality Higher for Deprived, Minority Children

Children from deprived and ethnic minority backgrounds are more likely to die following admission to paediatric intensive care units (PICU), according to a UK study. 

The research analysed 245,099 admissions to PICUs between 2008 and 2021, covering 163,163 children across the UK.

Overall, 63·1% of PICU admissions were unplanned. Among children for whom ethnicity data were available, 61.4% of admissions were children of White ethnicity, 9.2% Asian, 4.4% Black, 2.8% multiple ethnicities, and 2.4% were classed as ‘other’.

The study was conducted by a team from Imperial College London, University College London, and the universities of Leicester, Leeds, and Bristol.

Poverty Increases PICU Mortality Odds

The research, published in The Lancet Child & Adolescent Health, revealed that children living in areas with higher levels of poverty were more likely to be admitted to PICUs, were more severely ill on arrival, and were less likely to survive than children from the least deprived areas.

Overall PICU mortality across planned and unplanned admissions was 3.7%. This ranged from 3.1% for children in the least deprived quintile to 4.2% among children in the most deprived. 

Children living in the most deprived areas had 13% higher odds of death after PICU admission than those living in the least deprived areas.

Mortality Highest Among Asian Children 

Children of ethnic minority backgrounds were more likely than White children to have longer PICU stays (average 66 versus 52 hours) and unplanned readmission to PICU within 60 days of discharge (9% versus 6.8%). 

Asian children had the highest crude mortality rate at 5.1%, compared with 3.2% for White children.

Children of multiple and ‘other’ ethnicities also had higher odds of dying, with odds ratios of 1.23 and 1.20 respectively.

There was no statistically significant difference in mortality between Black and White children (OR 1.04).

The researchers noted that although ethnicity was known to contribute to differences in mortality and other health inequalities in children, their study was the first to report worse intensive care outcomes among children from more deprived backgrounds. They concluded that targeted community and hospital-based interventions are needed to improve PICU outcomes.

Early Disparities Highlighted

Lead researcher Dr Hannah Mitchell, from the Department of Surgery and Cancer at Imperial College London (ICL), said that the disparities mirror those seen in adults, but emerge much earlier, with 44% of children admitted to PICU under 1 year old and 70% under 5 years old. 

“This suggests that the effects of deprivation and systemic inequality begin very early in life, long before adult risk factors come into play,” she told Medscape News UK.

Mitchell said that the research team had secured funding to explore why children from more deprived areas, and those of Asian ethnicity, often arrive in PICU more unwell and may continue to deteriorate after admission. A further study would investigate how this might be prevented, she said.

Senior author Professor Padmanabhan Ramnarayan, also from ICL, described the findings as “worrying”. He warned that PICU use is likely to rise as more children develop complex chronic conditions.

Dr Helen Stewart, officer for health improvement at the Royal College of Paediatrics and Child Health, said that the study revealed the “deeply alarming” depth of child poverty in the UK.

“As a paediatrician, I am increasingly disturbed by the rising number of children presenting with poverty-related illnesses,” she told Medscape News UK. 

Stewart added that “poverty is a key determinant of health, shaping children’s wellbeing and elevating mortality risk in areas of greatest deprivation”.

Experts Call for Urgent Action

The study followed recent findings from the National Child Mortality Database (NCMD), which reported that over half (54%) of the 9517 deaths in children aged 0 to 17 in England occurring between 1 April 2019 and 31 March 2022 involved children with life-limiting conditions.

Karen Luyt, a professor in neonatal medicine at the University of Bristol, and NCMD programme lead, told Medscape News UK: “A plausible hypothesis would be that underlying life limiting conditions might explain the higher mortality rate of Asian children on UK PICUs.”

The research was commissioned by the Healthcare Quality Improvement Partnership (HQIP) through its national paediatric intensive care audit network (PICANet). 

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.