Socioeconomic Status In Pediatric Health Research And Its Association With Critical Illness And Outcomes

Children admitted to the pediatric intensive care unit represent a vulnerable population because of the seriousness of their health conditions and the delivery of critical care measures that include sedation and invasive procedures. Critically ill children of low socioeconomic status may be more at risk for greater illness severity upon admission to the pediatric intensive care unit and worst outcomes after discharge. We know that socioeconomic factors can adversely affect the health of children but how these factors specifically interact with aspects of pediatric critical care is not well understood. Current measurement practices of socioeconomic status in healthcare research vary widely, making comparisons between studies challenging. Furthermore, the choice of one socioeconomic measure over another in health research can result in different findings and subsequent conclusions. A new look into current socioeconomic status measurement practices is warranted; in addition, how a particular socioeconomic status measure is associated with critical illness and outcomes has not been studied in a large, United States-based, geographically diverse cohort of children mechanically ventilated for acute respiratory failure. This dissertation will use data from the RESTORE clinical trial [U01HL086622 and U01 HL086649(PI: Curley & Wypij), a 31-site cluster randomized trial of a nurse-implemented sedation management intervention on mechanically ventilated children hospitalized for acute respiratory failure] to conduct secondary analyses on measures of illness severity, socioeconomic status, and health outcomes that include resource use and health-related quality of life. By exploring associations between socioeconomic status, illness severity, and post-discharge outcomes, this dissertation will contribute new knowledge regarding how children of various socioeconomic backgrounds present upon admission and how they fare when they return home to their families.