Publication
Social Determinants of Health And End-Of-Life Circumstances in A Quaternary Children's Hospital
Jamieson T, Liu J, Goldberg S, Ting J, Fox M, Rosenberg A, Heneghan C, Kwan S, Schicho F, Vitali S, Kheir J, Johnston E, Thiagarajan R, Weller E, Ward V, Moynihan K · Journal of pain and symptom management · 2026
CONTEXT: 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 and subspecialty pediatric palliative care (SPPC) utilization, although pediatric data remain limited. OBJECTIVE(S): To examine relationships between SDoH, SPPC, and end-of-life circumstances among decedents in a quaternary children's hospital. METHOD(S): 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 end-of-life circumstances (end-of-life care intensity, peri-mortem 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. RESULT(S): Among 679 pediatric decedents (median age 19 months [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]), and 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 were associated with SPPC. For end-of-life circumstances, international/self-pay insurance was associated with lower end-of-life intensity (0.45 [0.20-1.01]), and interpreter involvement 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 ICU stay (3.83 [1.88-7.78]). SPPC was associated with less intense care and CPR. CONCLUSION(S): Clinical factors and certain social determinants, specifically insurance type and interpreter usage, were associated with SPPC involvement and end-of-life outcomes.Copyright © 2026. Published by Elsevier Inc.
Synced from the TRENDS in Pediatric Palliative Care Zotero library, curated by The Siden Research Team. ICPCN does not host or verify the full text.