TOPLINE

Children living in the most deprived areas of England experienced significantly higher rates of paediatric ICU (PICU) admission for respiratory diseases than those living in the least deprived areas. Those from neighbourhoods with the highest exposure to cigarette smoke also had higher rates of respiratory PICU admission than those from neighbourhoods with the lowest exposure, independent of age, sex, ethnicity, and deprivation.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from the Paediatric Intensive Care Audit Network to assess whether ethnicity, area-level deprivation, and neighbourhood cigarette smoke exposure were associated with PICU admissions and outcomes for respiratory disease among children in England.
• The analysis included 41,859 respiratory PICU admissions for 30,442 children younger than 16 years between 2014 and 2023; admissions were classified as infection-related (54.8%), non-infection-related (40.0%), or asthma-related (5.2%).
• The main outcome was the incidence of admissions to the PICU for respiratory diseases.

TAKEAWAY

• Children living in the most deprived areas had a 73% higher incidence of respiratory PICU admissions than those living in the least deprived areas after adjustment (adjusted incidence rate ratio [IRR], 1.73; P < .001).
• Children living in neighbourhoods with the highest exposure to cigarette smoke had a 26% higher incidence of respiratory PICU admissions than those living in neighbourhoods with the lowest exposure after adjustment (adjusted IRR, 1.26; P = .043).
• Asian and Black children had a significantly higher incidence of respiratory PICU admissions than White children (IRR, 1.45 and 1.65, respectively; P < .001 for both), with the greatest disparities observed for asthma-related admissions.
• Asian children admitted to the PICU had approximately 2.1-fold higher odds of in-PICU mortality than White children, and children living in the most deprived areas had 1.6-fold higher adjusted odds of in-PICU death than those living in the least deprived areas (P < .001 for both); no significant association was observed between neighbourhood cigarette smoke exposure and in-PICU mortality.

IN PRACTICE

"[These] findings call for additional restriction in public outdoor spaces within neighbourhoods with high child footfall and tobacco control strategies that aim to reduce population-level smoking. Additionally, we must mitigate barriers to care access within vulnerable communities, such as children of minoritised ethnicity and those from areas with the highest deprivation, to reduce preventable childhood respiratory morbidity and mortality," the authors of the study wrote.

SOURCE

The study was led by Subashan Vadibeler, Leeds Institute for Data Analytics, University of Leeds, Leeds, England. It was published online on September 11, 2026, in Archives of Disease in Childhood.

LIMITATIONS

The ecological study design may be subject to ecological fallacy. Individual-level tobacco smoke exposure was not directly measured, and the prevalence of neighbourhood-level smoking may not have accurately reflected personal smoke exposure. Important confounders — including comorbidities, breastfeeding, vaccination status, overcrowding, air pollution, nutrition, and access to primary care — were unavailable.

DISCLOSURES

The authors did not declare any specific grant for this study from any funding agency in the public, commercial, or not-for-profit sectors. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.