Disparities in socioeconomic status
In this review we describe the influence of socioeconomic, environmental
and ethnic disparities on PICU outcomes in childhood respiratory
diseases. Children from families living in poverty or being minorities
not only comprise a higher proportion of PICU admissions for respiratory
diseases27,28, but there is an association with higher
mortality rates as well29. A few possible proposed
explanations for the higher prevalence of respiratory diseases and the
higher proportion of deaths in this group are psychosocial processes,
such as parental stress, overcrowding, illiteracy and
malnutrition27,29. Socioeconomic inequalities tend to
have an effect on the morbidity at the PICU as well: children from
deprived neighborhoods have a higher severity of illness, a larger
chance on respiratory failure and were mechanically ventilated more
frequently16,27,30. Usually, being a minority and
living in a neighborhood with other minorities tends to be protective,
but these studies state otherwise, even after correcting for factors
such as ethnicity, income and insurance16. This
finding of increased morbidity may be explained by low acculturation and
health illiteracy (e.g. parents or child only skilled in speaking native
language in an English-speaking country, or lessened understanding of
the health care system), which could in turn lead to decreased knowledge
about medical care options16. Moreover, a low
collective social capital could lead to neighborhoods where neighbors
are not able to help each other and result in further
impoverishment16. Finally, socioeconomic status may
lead to a more severe disease course because of a lower parental
education level, more exposure to indoor smoking, a limited access to
healthcare, suboptimal medical care during emergencies, and structural
problems in public health care services30. Previous
studies describing the connection between poverty and outcomes in
critically ill children derived these effects to limited knowledge about
preventive primary care and an unhealthy lifestyle31.
With the increasing food prices, the choice for unhealthier and often
cheaper food is easily made.