629: VARIATION OF PEDIATRIC EXTRACORPOREAL MEMBRANE OXYGENATION UTILIZATION BY SOCIOECONOMIC STATUS

Abstract

Introduction: Previous studies demonstrate variation in extracorporeal membrane oxygenation (ECMO) utilization by race and payer. However, limited data examine relationships with socioeconomic status (SES) and no analyses employ multidimensional neighborhood-level tools. Methods: This is a retrospective cohort analysis of admissions to 49 pediatric hospitals in the Pediatric Health Information Systems database. We identified children (< 18 years) born at term (>35 weeks) requiring intensive care with “high” or “very high” illness severity (10/1/2015 to 3/1/2021). Primary SES predictor was the Childhood Opportunity Index (COI), a multidimensional SES tool comprising 29 neighborhood-level indicators. COI was measured from 0 to 100 with lower COI indicating lower SES. We compared patient variables across 3 outcomes: supported on ECMO, survival without ECMO and those who died without ECMO (DWE). Multivariable analysis compared patients supported on ECMO and the DWE cohort adjusting for clinical covariates. Results: Of 331194 children included, 9071 (2.7%) were supported on ECMO, 308490 (93.1%) survived without ECMO and 13633 (4.1%) DWE. The ECMO cohort had a higher proportion of cardiac patients (65% vs 39% in both survived and DWE; p< 0.001). Patients who DWE had lower SES (median COI[IQR] 41 [19,66]) compared with patients who survived without ECMO (44 [20,70]) or supported on ECMO (47 [22,72]; p< 0.001). There was a higher proportion of patients with diverse racial backgrounds (versus white) in the DWE population (45%) than those that survived (42%) or received ECMO (39%; p< 0.001). Outcomes differed by payer with proportions of patients who were supported on ECMO, survived or DWE who were publicly insured (57% vs 62% vs 63%) vs privately insured (41% vs 35% vs 32%; p< 0.001). In the multivariable analysis for every 5 points lower COI, the odds of DWE increased by 2%. Independent predictors of DWE included lower COI, pediatric respiratory failure, younger age, comorbidities, Asian or other race, residence closer to hospital, and non-midwest centers. Conclusions: Social determinants of health influence ECMO utilization. Lower SES is independently associated with greater odds of DWE. Further research is needed to understand the systemic, hospital-level and individual factors contributing to health disparities.