(836) The Association Between Social Determinants of Health and Pediatric Rapid Response Activation

Introduction: Rapid Response Teams (RRT) may improve outcomes for pediatric patients. However, inequities in rates of RRT activations for Hispanic and non-English speaking patients have been shown. We sought to determine whether social determinants of health (SDoH), including preferred language, income level (via area deprivation index [ADI]), race and ethnicity, were associated with RRT activations.

Methods: We identified all hospitalizations among children ages 0-21 years eligible to receive a RRT, and all pediatric RRT events between January 2019 and December 2023, at a single center, academic institution in Michigan. Hospitalized patients were eligible to receive a RRT if they were hospitalized in any unit outside of an intensive care unit or the wellborn nursery. We fit a generalized linear mixed model to determine the likelihood of RRT activation during the hospitalization. Covariates included preferred language, ADI (where higher ADI indicates a more disadvantaged area), race, ethnicity, age, and sex.

Results: There were 209,980 pediatric hospitalizations for 114,456 patients, for which 2,210 RRT events occurred. Overall, 48.7% of hospitalizations were among female patients, with a median age of 6.9 years (IQR 2.1-15.1). Among hospitalizations with an RRT, 43% were female; 69% identified as White, 18% as Black/AA, and 13% as another race or unknown, with 8.6% identifying as Hispanic. In total, 3.1% and 4.5% preferred a language other than English, for non-RRT and RRT hospitalizations, respectively (p < 0.001). In adjusted analysis, non-English speaking patients and those with higher ADI had greater odds of having an RRT ([Odds ratio (OR)=1.45; 95% CI 1.1-1.91, p=0.008] and [OR=1.08; 95% CI 1.06-1.1; p< 0.001], respectively). Furthermore, older patients were associated with lower odds of RRT events (OR=0.97; 95% CI 0.96-0.97) and male patients were associated with greater odds of RRT events (OR=1.24; 95% CI 1.12-1.37; p< 0.001).

Conclusions: Hospitalized pediatric patients who prefer a language other than English and those with greater economic disadvantage have greater odds of RRT events. Further investigation into the etiology of these disparities should be conducted to inform improvement efforts to close these gaps.