Abstract
Within the UK, child mortality from all causes has declined for all ages over the last three decades. However, distinct inequality remains, as child mortality rates are generally found to be higher in males. A significant proportion of childhood deaths in the UK occur in Paediatric Intensive Care Units (PICU). We studied the association of sex with infant mortality in PICUs. We included all infants (0 to 12 months old) admitted to UK PICUs from 01/01/2005 to 31/12/2015 using the Paediatric Intensive Care Audit Network (PICANet) dataset. We considered first admissions to PICU and fitted a cause-specific-hazard-ratio (CSHR) model, and a logistic model to estimate the adjusted association between sex and mortality in PICU. Pre-defined subgroups were children less than 56-days old, and those with a primary diagnosis of infection. Of 71,243 cases, 1,411/29,520 (4.8%) of females, and 1,809/41,723 (4.3%) of males died. The adjusted male/female CSHR was 0.87 (95%-CI 0.81 to 0.92) representing a 13% higher risk of death for females. The adjusted OR for male to female mortality is 0.86 (95%-CI 0.80 to 0.93). Analyses in subgroups yielded similar findings. In our analysis, female infants have a higher rate of PICU mortality compared to male infants.
Highlights
The data is collected by individual Paediatric Intensive Care Units (PICU) as daily activity data, or Paediatric Critical Care Minimum Data Set (PCCMDS)[16]
We removed children who were still in PICU after 100 days (n = 192) as these were considered to have an atypical Length of Stay (LOS)
Given that a sizable proportion of childhood deaths in the UK occur in PICU, we deemed PICU admissions a relevant cohort in which to examine potential sex differences in infant mortality
Summary
The aim of the DAGs are to clarify the relationship between sex and mortality in PICU, in the presence of other causally linked variables. This is to ensure the correct adjustments are made in the analysis to avoid inducing a false association between sex and death in PICU. ( reproduced as DAG C in Supplemental Digital Content) indicated that, in order not to bias the relationship between sex and mortality in PICU, we had to adjust our statistical models for the variable PIM2R. We fitted a logistic model including death as outcome, sex as expsoure and PIM2R as an adjustment variable, based on the study of variable relationships (Figure 1 DAG). The Collection of personally identifiable data for the PICANet project has been approved by the Patient Information Advisory Group ( the Health Research Authority Confidentiality Advisory Group) and ethical approval granted by the Trent Medical Research Ethics Committee, ref. 18/EM/0267
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