Ethnic minority and poorer children more likely to die in intensive care

Children from ethnic minority backgrounds and those living in areas with higher levels of child poverty are more likely to die in intensive care than White children and those from the least deprived areas.

Researchers, including those from the University of Leicester, analysed 14 years of UK-wide data on more than 160,000 critically ill children and found that children of Asian, multiple and other ethnicities are more likely to die in intensive care than White children.

They also found that children living in areas with higher levels of poverty are more severely ill on arrival to intensive care and more likely to die after admission to paediatric intensive care than those from the least deprived areas.

The study, published in The Lancet Child & Adolescent Health, also reveals that children of ethnic minority backgrounds are more likely to stay longer in intensive care and to be readmitted unexpectedly after discharge, compared to White children.

It is the first study of its kind in the UK to report worse intensive care outcomes in children from more deprived areas and was led by researchers at the University of Leicester, Imperial College London, UCL and University of Leeds.

They say the findings raise serious concerns about equity in critical care for children and should prompt urgent action from policymakers and healthcare leaders. 

Dr Sarah Seaton, Associate Professor in Perinatal and Paediatric Research in Population Health at the University of Leicester, and senior author on the paper said: “These findings are deeply concerning for those children who require critical care and their families. Without doubt this should be a place for health equality but instead what we have found highlights this is not the case. Instead, huge inequalities exist for those who are not of white ethnicity and unless this is tackled the gap could widen even further. Additionally, given that child poverty is also rising, and that children are the most vulnerable members of society, ensuring health care is equal for all must be a priority for our healthcare leaders.” 

Dr Hannah Mitchell, lead author of the study from the Department of Surgery and Cancer at Imperial College London, said: “Our findings raise serious concerns about equity in critical care for children. Paediatric intensive care offers the highest level of support for the sickest children. The fact that inequalities persist even at this stage of care is deeply troubling. These are not just statistics —they represent real, preventable differences in outcomes for critically ill children.

“Our findings are especially alarming in the context of rising levels of child poverty in the UK, where 4.5 million children are now growing up in poverty (31% of all children), 800,000 more children compared to 2013 (27% of all children). These findings should prompt urgent action from policymakers and healthcare leaders.

“Ethnic inequalities in child health have been highlighted repeatedly, and our study adds clear, national-scale evidence of disparities in intensive care. Reducing avoidable deaths in children must include serious, sustained action to reduce child poverty, improve access to healthcare, and address the structural barriers faced by marginalised communities.”

Professor Padmanabhan Ramnarayan, senior author of the study from the Department of Surgery and Cancer at Imperial College London, added: “Our study reveals worrying inequalities in outcomes for children admitted to intensive care in the UK.

“This is particularly concerning as use of Paediatric Intensive Care Units (PICUs) is projected to rise in the coming years due to the increasing prevalence of complex chronic conditions in children.

“It shouldn’t be the case that a child’s ethnicity or postcode determines their outcomes in PICU. 

“Our findings show the urgent need for improved access to urgent care, reducing barriers to healthcare access, earlier recognition of serious illness in children, and more coordination between hospitals and community care teams to improve PICU outcomes across the UK.”

Children from economically disadvantaged areas or minority ethnic backgrounds experience worse health outcomes across a range of acute care conditions, with most of this research originating from the USA.

Evidence from the UK and the USA shows increased rates of admissions to PICUs for children from more deprived areas, and a previous Imperial study also reported increased rates of PICU admissions for children of Asian and Black ethnicities in the UK.

However, less is known about how this increased risk of admission to PICU relates to outcomes after admission.

In this new study, the team wanted to explore the effects of ethnicity and deprivation on PICU outcomes. They analysed nationwide data from the Paediatric Intensive Care Audit Network of 245,099 admissions for 163,163 children aged 0-15 years admitted to UK PICUs between 1 Jan 2008 and 31 Dec 2021.  

They analysed ethnicity and area-level deprivation at the time of admission. They compared this with mortality, length of stay during PICU and unplanned readmission within 60 days.

The team found that children of Asian ethnicity had higher mortality – 1,336 deaths per 26,022 admissions, while mortality was lowest amongst White children – 4,960 deaths per 154,041 admissions. Children of Asian ethnicity had 52% higher odds of death compared to White children. 

Children of multiple ethnicities and other ethnicities represented 2.8% (4514 children) of the overall group and had 20% higher odds of PICU mortality compared to White children.

Mortality was also higher in children living in areas with higher levels of child poverty – 2,432 deaths per 58,110 admissions compared to children in least deprived areas – 1,025 deaths per 33,331 admissions, revealing an association between PICU mortality and area-level child poverty. Children living in the most deprived areas had 13% higher odds of death compared to those living in the least deprived areas. 

Both children of Asian ethnicity and children from more deprived areas were more severely unwell at admission than children of White ethnicity and those from less deprived areas. Children from ethnic minority backgrounds had longer stays in PICU (average 66 hours) and increased odds of unplanned readmission to PICU within 60 days (9%) compared with those of White ethnicity (average 52 hours and 6.8%). 

The team has secured funding from the National Institute of Health and Care Research to explore the possible reasons for the inequalities, such as access to healthcare, education and language in a further study.