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Poor children have highest in-hospital death rate

By Kerry Grens

NEW YORK (Reuters Health) - Children from poorer neighborhoods who are hospitalized are more likely to die before discharge than kids from wealthier areas, according to a new study.

These differences persisted even though the number of deaths for all kids at the hospitals studied was lower than expected.

"Even despite our highest quality pediatric care in this country, some of those disparities continue to exist," said Dr. Jeffrey Colvin, the lead author of the study and an assistant professor at the University of Missouri-Kansas City School of Medicine.

Colvin's findings are consistent with other studies outside of the hospital relating low income with a higher chance for sickness and death.

He and his colleagues gathered information from 42 free-standing children's hospitals across the U.S., including more than 1,000,000 admissions during 2009 and 2010.

Among the patients, 8,950 of them died within the hospital. The researchers found a progressively greater number of deaths as income declined.

While 0.7 percent of those kids from the wealthiest neighborhoods died, 0.8 percent of kids from the second-wealthiest neighborhoods died and 0.9 percent of children from the two poorest zip code groups died.

The number of deaths among kids from the poorest areas was 29 percent greater than among the wealthiest kids.

"There's a lot of different ways that poverty gets under the skin. Part of it is through simple material deprivation: not enough food or poor housing, lack of access to health care. It also has to do with neighborhood factors, such as access to healthy food or violence within the neighborhood," Colvin told Reuters Health.

DIFFERENCES BY CONDITIONS

In some cases, such as for children with cancer, respiratory problems or infectious diseases, income didn't matter - kids were just as likely to die regardless of the wealth of their neighborhood.

However, for patients in five different specialties - neonatal, heart, gastrointestinal, neurology and surgery - the relationship between income and dying in the hospital persisted.

For instance, 4.3 percent of neonatal patients from the poorest neighborhoods died, compared to 2.6 percent of neonatal patients from the wealthiest areas.

Similarly, 1.8 percent of poor cardiac patients died, while 1.3 percent of wealthy heart patients died.

Colvin said it's not clear why some conditions seem immune to income factors. "Perhaps poverty affects cancer differently than it affects cardiac problems," he suggested.

Dr. Scott Lorch, an associate professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, said he's not surprised to see that disparities exist for particular parts of the hospital.

In neonatology, for instance, where a lot of the babies are preemies, it's the health of the mother that plays a big role, and research has shown that the mother's health is also tied up in socioeconomic factors.

ROLE OF INSURANCE?

Colvin's "data are pretty consistent with what is known about how the environment that people live in influences their health outcomes," said Lorch, who was not part of the study.

"If women don't have adequate access to care, you may see untoward effects on the babies after they're delivered," Lorch, who is also a neonatologist at the Children's Hospital of Philadelphia, added.

For all income groups, Colvin's team found, the patients at these 42 children's hospitals were less likely to die than would be expected at all hospitals in the U.S.

One potential explanation is that nearly all of the children had health insurance.

"This supports the theories that health insurance has a protective effect against mortality or poor health. And these free-standing hospitals are very good at identifying kids without insurance and getting them enrolled," he said.

It's also possible that because the hospitals are dedicated to pediatric care, they might perform better.

"It's great that with this high quality medical care that the mortality will be less than expected, but it can't overcome what we're guessing is the impact of poverty on a child before they come through the door," he said.

SOURCE: http://bit.ly/12CunNt Pediatrics, online December 17, 2012.

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