O3014: Association Between Race/ethnicity and Ventilator Associated Pneumonia in the Pediatric Intensive Care Unit: A Retrospective Analysis

Background: Racial/ethnic disparities afflict children at multiple levels of healthcare and health. Adult ICU literature suggests higher risk-adjusted rates of healthcare associated infections in patients from diverse racial/ethnic groups. Hispanic/Latinx adult patients, compared to their white counterparts, are at higher risk for ventilator associated pneumonia (VAP). VAP is a potentially modifiable complication of critical illness associated with worsened morbidity and mortality. Therefore, the objective of this study was to analyze the association between race/ethnicity and VAP in pediatric patients.

Methods: Retrospective observational data was extracted from the HCUP KID database. Children 18 years and younger who had diagnoses of endotracheal intubation and VAP, based on ICD10 coding, were included in the study. Children with incomplete data were excluded. The primary outcome was the diagnosis of VAP. Univariate and multivariate odds ratio (OR) were used to determine the odds of VAP by race/ethnicity with and without adjustment for demographic, clinical, and socioeconomic variables available in the dataset.

Results: A total of 703 patients met the inclusion criteria for our study; 51% (n = 359) were white, 25% (n = 176) were Black/African-American, and 24% (n = 168) were Hispanic/Latinx. Both Black/African-American and Hispanic/Latinx children resided in lower income neighborhoods and were more likely to have public health insurance. Hispanic/Latinx patients did not demonstrate a significant difference in univariate OR (1.09, 95 %CI 0.91-1.31) or multivariate adjusted OR (0.97, 95 %CI 0.8-1.18) of VAP. However, Black/African American children had significantly increased univariate OR (1.09, 95 %CI 1.16-1.66) and multivariate adjusted OR (1.28, 95 %CI 1.06-1.56) of VAP.

Conclusion: In a retrospective observational study utilizing a large national database of hospitalized patients, Black/African-American children had higher odds of suffering from ventilator associated pneumonia compared to their white counterparts even after adjustment for available socioeconomic and demographic variables. Furthermore, in comparison to adult literature, Hispanic/Latinx patients did not demonstrate higher odds of suffering from VAP compared to their white counterparts. These data suggest VAP as a possible contributor to worsened health outcomes among Black/African-American children. Poor adherence to standard bundles designed to decrease VAP, low volume providers, differences in illness progression at time of presentation, and implicit bias may contribute to this finding.