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Original article

Vol. 141 No. 1718 (2011)

Are immigrant children admitted to intensive care at increased risk?

  • T Tritschler
  • FH Sennhauser
DOI
https://doi.org/10.4414/smw.2011.13190
Cite this as:
Swiss Med Wkly. 2011;141:w13190
Published
25.04.2011

Abstract

BACKGROUND: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.

METHODS: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 wereexpected mortality, standardised mortality ratio, proportion of immigrants in general population and in PICU.

RESULTS: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.

CONCLUSIONS: 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.

References

  1. Howard I, Joseph JG, Natale JE. Pediatric traumatic brain injury: do racial/ethnic disparities exist in brain injury severity, mortality, or medical disposition? Ethn Dis. 2005;15:S5-51–6.
  2. Unequal treatment: confronting racial and ethnics disparities in health care. Washington, DC, Institute of Medicine, 2002.
  3. Lopez AM, Tilford JM, Anand KJ, Jo CH, Green JW, Aitken ME, et al. Variation in pediatric intensive care therapies and outcomes by race, gender, and insurance status. Pediatr Crit Care Med. 2006;7:2–6.
  4. Haider AH, Efron DT, Haut ER, DiRusso SM, Sullivan T, Cornwell EE. Black children experience worse clinical and functional outcomes after traumatic brain injury: an analysis of the National Pediatric Trauma Registry. J Trauma. 2007;62:1259–62; discussion 1262–3.
  5. Parslow RC, Tasker RC, Draper ES, Parry GJ, Jones S, Chater T et al. Paediatric Intensive Care Audit Network. Epidemiology of critically ill children in England and Wales: incidence, mortality, deprivation and ethnicity. Arch Dis Child. 2009;94:210.
  6. Office for National Statistics UK. Large differences in infant mortality by ethnic group, 2008. Available from http://www.statistics.gov.uk/pdfdir/imeth0608.pdf (accessed 14 June 2010)
  7. Claydon JE, Mitton C, Sankaran K, Lee SK. Ethnic differences in risk factors for neonatal mortality and morbidity in the neonatal intensive care unit. J Perinatol. 2007;27:448–52.
  8. Mayer L, Meuli M, Lips U, Frey B. The silent epidemic of falls from buildings: analysis of risk factors. Pediatr Surg Int. 2006;22:743–8.
  9. Slater A, Shann F, Pearson G. PIM2: A revised version of the Paediatric Index of Mortality. Intensive Care Med. 2003;29:278–85.
  10. Slater A, Shann F, McEniery J. The ANZPIC Registry diagnostic codes: a system for coding reasons for admitting children to intensive care. Intensive Care Med. 2003;29:271–7.
  11. Joye D, Schuler M, Meier U. Sozialstruktur der Schweiz. Bundesamt für Statistik, Bern, Switzerland, 1996.
  12. Statistisches Amt des Kantons Zürich, http://www.statistik.zh.ch. (accessed 14 June 2010).
  13. Rapoport J, Teres D, Lemeshow S, Gehlbach S. A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study. Crit Care Med. 1994;22:1385–91.
  14. Agency for Healthcare Research and Quality. 2007 National Healthcare Disparities Report. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; February 2008. AHRQ Pub. No. 08-0041.
  15. Dougherty D, Meikle SF, Owens P, Kelley E, Moy E. Children’s Health Care in the First National Healthcare Quality Report and National Healthcare Disparities Report. Med Care. 2005;43(3 Suppl):I58–63.
  16. Eidgenössische Volkszählung 2000, Ausländerinnen und Ausländer in der Schweiz. Bundesamt für Statistik, 2004. Available from http://www.bfs.admin.ch/bfs/portal/de/index/regionen/22/publ.Document.68548.pdf (accessed 14 June 2010).
  17. Naclerio AL, Gardner JW, Pollack MM. Socioeconomic factors and emergency pediatric ICU admissions. Ann N Y Acad Sci. 1999;896:379–82.
  18. Petrova A, Mehta R, Anwar M, Hiatt M, Hegyi T. Impact of race and ethnicity on the outcome of preterm infants below 32 weeks gestation. J Perinatol. 2003;23:404–8.
  19. Abdullah F, Zhang Y, Lardaro T, Black M, Colombani PM, Chrouser K, et al. Analysis of 23 million US hospitalizations: uninsured children have higher all-cause in-hospital mortality. J Public Health (Oxf). 2010;32(2):236–44.
  20. Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791–9.
  21. Althaus F, Paroz S, Renteria S-C, Rossi I, Gehri M, Bodenmann P. Gesundheit von Ausländern in der Schweiz. Schweiz Med Forum. 2010;10:59–64.
  22. Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283:2579–84.
  23. Potosky AL, Breen N, Graubard BI, Parsons PE. The association between health care coverage and the use of cancer screening tests. Results from the 1992 National Health Interview Survey. Med Care. 1998;36:257–70.
  24. Pincus T, Esther R, DeWalt DA, Callahan LF. Social conditions and self-management are more powerful determinants of health than access to care. Ann Intern Med. 1998;129:406–11.
  25. Brown ML, Potosky AL, Thompson GB, Kessler LG. The knowledge and use of screening tests for colorectal and prostate cancer: data from the 1987 National Health Interview Survey. Prev Med. 1990;19:562–74.
  26. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Health literacy. JAMA. 1999;281:552–7.
  27. Lannon C, Brack V, Stuart J, Caplow M, McNeill A, Bordley WC, et al. What mothers say about why poor children fall behind on immunizations. A summary of focus groups in North Carolina. Arch Pediatr Adolesc Med. 1995;149:1070–5.
  28. Fiscella K, Franks P, Clancy CM. Skepticism toward medical care and health care utilization. Med Care. 1998;36:180–9.
  29. Lannin DR, Mathews HF, Mitchell J, Swanson MS, Swanson FH, Edwards MS. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998;279:1801–7.
  30. Thomas LR, Fox SA, Leake BG, Roetzheim RG. The effects of health beliefs on screening mammography utilization among a diverse sample of older women. Women Health. 1996;24:77–94.
  31. Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.
  32. Whittle J, Conigliaro J, Good CB, Joswiak M. Do patient preferences contribute to racial differences in cardiovascular procedure use? J Gen Intern Med. 1997;12:267–73.
  33. Oddone EZ, Horner RD, Diers T, Lipscomb J, McIntyre L, Cauffman C, et al. Understanding racial variation in the use of carotid endarterectomy: the role of aversion to surgery. J Natl Med Assoc. 1998;90:25–33.
  34. van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians' perceptions of patients. Soc Sci Med. 2000;50:813–28.
  35. Heckman TG, Somlai AM, Peters J, Walker J, Otto-Salaj L, Galdabini CA, et al. Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care. 1998;10:365–75.
  36. Moss N, Carver K. The effect of WIC and Medicaid on infant mortality in the United States. Am J Public Health. 1998;88:1354–61.
  37. Currie J, Gruber J, Fischer M. Physician payments and infant mortality: evidence from Medicaid fee policy. Am Econ Rev. 1995;85:106–11.
  38. Hanratty M. J. Canadian national health insurance and infant health. AmEcon Rev. 1996;86: 276–84.
  39. Braveman P, Oliva G, Miller MG, Reiter R, Egerter S. Adverse outcomes and lack of health insurance among newborns in an eight-county area of California, 1982 to 1986. N Engl J Med. 1989;321:508–13.
  40. Fontana M, Bischoff A. Uptake of breast cancer screening measures among immigrant and Swiss women in Switzerland. Swiss Med Wkly. 2008;138:752–8.
  41. Valentin A, Jordan B, Lang T, Hiesmayr M, Metnitz PG. Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med. 2003;31:1901–7.
  42. Warrier I, Du W, Natarajan G, Salari V, Aranda J. Patterns of drug utilization in a neonatal intensive care unit. J Clin Pharmacol. 2006;46:449–55.