Sociodemographic Inequities in Pediatric Food-Related Choking and Its Complications

Introduction: Rates of hospitalizations and deaths due to food-related choking in children remain unchanged despite national prevention efforts, including the 2010 AAP policy statement. The aim of this study is to investigate the role of sociodemographic factors in food-related choking events.

Methods: A retrospective cohort study of patients aged under 4 years seen at a tertiary academic center with airway foreign-body related ICD-10 codes between 2013-2024 was conducted; patients were excluded if they choked on non-solid foods, were recently or currently ill, or had suspicion of an esophageal foreign body (e.g., coins, batteries, or magnets). Sociodemographic variables and encounter history were collected. Univariable and multivariable analyses were performed.

Results: Of 63 patients, mean age at presentation was 24.7 months., mean Social Vulnerability Index (SVI) was 0.36, 30% were female, 70% had English language preference, 47% identified as a racial/ethnic minority, and 40% had public insurance. Of these patients, 11% had low-dose CT findings concerning for aspiration, while 44% had radiographic findings. Additionally, 13% of patients had a foreign body removed in the ED; 87% of patients went to the OR, but 16% did not have a foreign body identified. Removed foreign bodies included nuts (40%), fishbone (16%), and carrots (10%). Some (10%) patients required prolonged intubation/PICU stay, and 2 patients became deceased.

Patients requiring prolonged intubation/PICU stay demonstrated significant differences in female sex (67% vs 26%), non-English language (33% vs 5%), and SVI (0.65 vs 0.33), indicating increased social vulnerability. Further, on multivariable linear regression, intubation/PICU stay was associated with higher social vulnerability (coefficient: 0.36; p = 0.006).

Conclusions: Our findings suggest higher social vulnerability is associated with potentially more severe aspiration events. Thus, additional food-choking prevention education efforts are needed, specifically targeting children under the age of 4 from disadvantaged backgrounds.