Health disparities of critically ill children according to poverty: the Korean population-based retrospective cohort study

Esther Park, Hyejeong Park, Danbee Kang, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Eliseo Guallar, Juhee Cho, Gee Young Suh, Joongbum Cho

Research output: Contribution to journalArticlepeer-review


Background: There is a lack of nationwide studies on critically ill patients’ health disparity under the National Health Insurance (NHI) system. We evaluated health disparities in intensive care unit (ICU) admission, outcomes, and readmission in impoverished children. Methods: We conducted a retrospective cohort study using a national database from the Korean NHI and Medical Aid Program (MAP). MAP supports the population whose household income is lower than 40% of the median Korean household income. We defined poverty as being a MAP beneficiary and compared the poverty and non-poverty groups. Patients between 28 days and 18 years old who were admitted to the ICU were included. Hospital mortality and readmission were analyzed with adjustment for patient characteristics, hospital type, and management procedures. Results: Out of 17,893 patients, 1153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There was more age-standardized mortality in the poverty group (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group did not have a statistically different risk of adjusted in-hospital mortality to those in the non-poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84–1.55) but had a higher readmission rate (hazard ratio 1.25, CI 1.09–1.42). Conclusion: Under the NHI system, the disparity in pediatric critical care outcomes according to poverty is not definite, but the healthcare disparity in pre- and post-hospital care is a concern. Further studies are required to improve pre- and post-hospital healthcare quality of impoverished children.

Original languageEnglish (US)
Article number1274
JournalBMC public health
Issue number1
StatePublished - Dec 2021
Externally publishedYes


  • Child
  • Critical care
  • Health disparity
  • Health status
  • Intensive care units
  • Mortality
  • National health insurance
  • Patient admission
  • Patient readmission
  • Poverty

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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