Association between sociodemographic factors, neighbourhood cigarette smoke exposure and critical illness due to respiratory condition among paediatric population in England, 2014–2023: a retrospective cohort study

OBJECTIVES: To investigate the association between sociodemographic disparities and area-level smoking with paediatric intensive care unit (PICU) respiratory admission risk and outcomes. DESIGN: Retrospective cohort study. SETTING: English PICUs. PATIENTS: Children aged <16 years admitted with respiratory illness between January 2014 and December 2023. MAIN OUTCOME MEASURES: Crude incidence of PICU admission and incidence rate ratios (IRRs). ORs for in-PICU mortality. RESULTS: Analysis included 41 859 admissions for 30 442 children. The respiratory admission IRRs were higher in children of Asian and Black ethnicity and in children from the most deprived areas compared with children of White ethnicity and those from the least deprived areas (IRR 1.5, 95% CI 1.3 to 1.7; IRR 1.7, 95% CI 1.4 to 1.9; adjusted IRR 1.7, 95% CI 1.4 to 2.2). Children living in areas with the highest cigarette smoke exposure had a higher respiratory admission IRR (adjusted IRR 1.3, 95% CI 1.1 to 1.5) compared with those in areas with the lowest exposure. Children of Asian ethnicity and those from the most deprived areas had a higher in-PICU mortality compared with children of White ethnicity and those from the least deprived areas (OR 2.1, 95% CI 1.8 to 2.5 and adjusted OR 1.6, 95% CI 1.2 to 2.0). CONCLUSIONS: Ethnicity and deprivation were associated with higher PICU respiratory admission incidence and poorer outcomes. Children from areas with higher cigarette smoke were more likely to require PICU admission for respiratory diseases. Community-focused tobacco control measures to reduce population-level smoking can benefit child respiratory health.