ArticleCritical care explorations2026
Race, Ethnicity, and Social Determinants of Health in PICU Mode of Death: Single-Center Retrospective Cohort Study.
Article in Critical care explorations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
importanceBlack and Hispanic/Latino patients are underrepresented in pediatric mode of death (MOD) studies. Although significant disparities have been reported, the associations of MOD with patient-level social determinants of health (SDOH) and the Child Opportunity Index (COI) are unknown.
objectivesTo investigate associations between PICU MOD, race and ethnicity, SDOH, and COI. DESIGN, SETTING, AND
participantsRetrospective, single-center cohort study at a twenty-four-bed PICU within a large safety-net, public hospital, including all PICU deaths between January 2010 and December 2019. MAIN OUTCOMES AND MEASURES: We examined MOD by race and ethnicity, COI, and SDOH, including preferred language, health insurance, single-parent household status, parental occupation, and healthcare barriers abstracted from medical records. MOD was categorized as limitation of artificial life-sustaining therapies/technology (LOT) or withdrawal of artificial life-sustaining therapies/technology (WOT), failed resuscitation (FR), and death by neurologic criteria (DNC).
resultsOf 238 deaths, Black non-Hispanic/Latino patients comprised 42% (n = 100), Hispanic/Latino patients of all races 35% (n = 83), and White non-Hispanic/Latino patients 19% (n = 46). LOT/WOT was the predominant MOD (75%, n = 174; LOT = 109, WOT = 65). Racial and ethnic groups showed significant differences in COI, SDOH, and healthcare barriers. Despite this, there were no significant differences in MOD by Race and Ethnicity, SDOH, or healthcare barriers. Median COI was lower for DNC compared to LOT and WOT, and for FR compared with WOT. However, when examined within individual racial and ethnic groups, there was no difference in median COI between FR, LOT, and WOT. CONCLUSION AND RELEVANCE: We found no differences in MOD by Race and Ethnicity, SDOH, or barriers. Median COI was lower for FR compared with WOT. This suggests that COI, as opposed to race and ethnicity, may play a role in pursuing or forgoing resuscitation at end-of-life. This study adds to the examination of pediatric healthcare disparities at end-of-life by including SDOH and COI data in MOD analysis.
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