Social Determinants of Health and End-of-Life Circumstances in a Quaternary Children's Hospital.
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- Record sourced from PubMed, PMID 42208873.
- Also identified by DOI 10.1016/j.jpainsymman.2026.05.010.
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Abstract
Inequitable access to quality care based on social determinants of health (SDoH) adversely impacts outcomes. Prior studies suggest that disparities extend to end-of-life (EOL) and subspecialty pediatric palliative care (SPPC) utilization, although pediatric data remain limited. To examine relationships between SDoH, SPPC, and EOL circumstances among decedents in a quaternary children's hospital. We conducted a retrospective cohort study of all inpatient deaths at a quaternary pediatric hospital (1.1.2018-12.31.2023). Clinical data, SDoH (race/ethnicity, interpreter involvement, insurance, and Child Opportunity Index [COI3.0]), SPPC consultation, and EOL circumstances (EOL care intensity, peri‑mortem cardiopulmonary resuscitation [CPR]) were analyzed using multivariable regression with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented. COI and race/ethnicity were modeled separately given collinearity. Among 679 pediatric decedents (median age 19 months [Interquartile range (IQR) 0.4-130]; 44.3% female), SPPC was involved in 334 cases (49.2%). SPPC involvement was inversely associated with age (i.e., aOR [CI] for infants vs. older children 0.39 [0.22-0.67]), general surgical diagnoses (0.49 [0.25-0.99]), international/self-pay insurance (0.18 [0.07-0.48]), and positively associated with certain subspecialties (i.e., hematology/oncology, cardiac, and chronic respiratory diagnoses aORs 9.02 [4.99-16.32], 1.65 [1.11-2.45] and 2.66 [1.67-4.24], respectively) as well as greater numbers of comorbidities. Neither COI nor race/ethnicity was associated with SPPC. For EOL circumstances, international/self-pay insurance was associated with lower EOL intensity (0.45 [0.20-1.01]), while interpreter involvement was associated with higher odds of CPR on the day of death (2.27 [1.22-4.24]), CPR as the mode of death (1.91 [0.97-3.74]), and prolonged intensive care unit stay (3.83 [1.88-7.78]). SPPC was associated with lower EOL intensity and less CPR. Clinical factors and certain social determinants, specifically insurance type and interpreter usage, were associated with SPPC involvement and EOL outcomes.