Are immigrant children admitted to intensive care at increased risk

T Tritschler,Fh Sennhauser,B Frey

doi:10.4414/smw.2011.13190

Abstract

Racial and ethnic disparities in health care are significant predictors of the quality of health care received. Studies documenting these disparities are largely based on an adult chronic care model. There are only few reports in paediatric populations. Our objective was to evaluate the severity of illness of immigrants at admission to PICU, the proportion of immigrants in PICU compared to the general population and the quality of care they receive, in order to examine whether there are disparities in health care. Prospectively collected data of 1009 sequential first admissions in 2007 to a multidisciplinary, 19-bed, PICU of a university children's hospital in Switzerland. The main outcome measures were expected mortality, standardised mortality ratio, proportion of immigrants in general population and in PICU. Children with an immigrant background are overrepresented in PICU compared with their proportion in the general population. Parents of these children are more likely to be in the lowest strata of socio-professional status than parents of Swiss children hospitalised in PICU (relative risk 9.82, 95% CI 5.16 to 18.7). However, the distribution of immigrant children and Swiss children along the strata of illness severity is equal and there is no difference in standardised mortality ratio between these two groups. These findings indicate that disparities may exist at a lower level of illness severity, due to many possible reasons (for example shortcomings in primary health care). However, once a child enters tertiary health care, nationality and socio-economic factors no longer influence quality of health care delivery.

Highlights

Despite a study suggesting that racial and ethnic disparities in brain injury severity, mortality and medical disposition do not exist in paediatric health care treatment [1], there is evidence from studies in the United States of America that racial and ethnic disparities in health care are significant predictors of the quality of health care received, even after controlling for previously known factors such as access to care and other socioeconomic circumstances [2]
Our objective was to evaluate the severity of illness of immigrants at admission to paediatric intensive care unit (PICU), the proportion of immigrants in PICU compared to the general population and the quality of care they receive, in order to examine whether there are disparities in health care
Parents of these children are more likely to be in the lowest strata of socio-professional status than parents of Swiss children hospitalised in PICU

Summary

Introduction

Despite a study suggesting that racial and ethnic disparities in brain injury severity, mortality and medical disposition do not exist in paediatric health care treatment [1], there is evidence from studies in the United States of America that racial and ethnic disparities in health care are significant predictors of the quality of health care received, even after controlling for previously known factors such as access to care and other socioeconomic circumstances [2]. In a previous study in our paediatric intensive care unit (PICU) we found, that children under the age of 16 with immigrant background and parents with a lower socio-professional status were overrepresented in a group of patients suffering from head injuries and multiple trauma due to falls from windows and balconies [8]. This led us to the assumption that immigrant background and socio-professional status may have an impact on severity of illness of the patients at admission to the PICU. The objectives of this study were to evaluate the severity of illness of immigrants at admission to PICU, their proportion in PICU compared to the general population, the quality of care they received and their outcome (standardised mortality ratio)

Objectives

Methods

Results

Discussion

Conclusion