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The impact of socioeconomic inequities and small-area deprivation on child inpatient care
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Socioeconomic inequities are associated with longer length of hospital stay (LOS) and clinical severity in children. This retrospective cross-sectional study analyzes health inequalities and area-level deprivation, focusing on hospitalization indicators, in a suburban pediatric population in Portugal. Pediatric admissions to a local general hospital were analyzed for LOS and admission to intensive care unit (ICU), as well as their relation to socioeconomic factors, over an 8-year period (2014 to 2021), using population-averaged models. Area-level inequalities were measured for the population ranked by civil parishes’ European Deprivation Index. 8016 admissions were included. Health inequalities associated with socioeconomic deprivation were observed, with concentration curves above the diagonal for LOS and admission to ICU and located in urban and densely populated civil parishes. Neonatal age showed the highest mean LOS ratio (MR = 2.29, 95% CI 1.96; 2.67, p < 0.001) and ICU admission odds (OR = 9.25, 95% CI 4.84; 17.68, p < 0.001). Mean LOS ratio was significantly higher for Black ethnicity (MR = 1.19; 95% CI 1.10; 1.28, p < 0.001) and lower maternal education. Odds of admission to ICU was significantly higher for male gender (OR = 1.25, 95% CI 1.01; 1.55, p = 0.048) and mother’s unskilled occupation (OR = 1.66, 95% CI 1.09; 2.53, p = 0.019). Paternal manual skilled occupation demonstrated 17% higher mean LOS ratio (p < 0.001) and 51% higher odds of admission to ICU (p = 0.019). Public policies must be culturally competent and target socioeconomic and geographical deprivation.
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Palavras-chave
children ethnicity health inequities hospitalization pediatric intensive care Portugal social determinants of health Pollution Public Health, Environmental and Occupational Health Health, Toxicology and Mutagenesis SDG 3 - Good Health and Well-being