Social Determinants of Health and Healthcare Utilization in Infants With Bronchopulmonary Dysplasia.

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Pulmonology Pub Date : 2025-06-01 DOI:10.1002/ppul.71153

Haley Urbach, Sharon Ostfeld-Johns, Sarah McCollum, Pnina Weiss, Sarah Kandil, Eliaz Brumer

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Abstract

Background and objectives: Infants with bronchopulmonary dysplasia (BPD) are at high risk for adverse health outcomes, yet the influence of social determinants of health (SDOH) in shaping disparities and healthcare utilization remains poorly understood. This study evaluates the impact of SDOH on healthcare utilization in infants with BPD during the first-year post NICU discharge.

Methods: We conducted a retrospective study of 161 infants with BPD discharged from the NICU between January 2021 and December 2023. Key SDOH variables included the Area Deprivation Index (ADI), Childhood Opportunity Index (COI), and insurance type. Primary outcomes were healthcare utilization within the first year after NICU discharge, including emergency department (ED) visits, hospital admissions, pediatric pulmonology follow-up, and medication use.

Results: Infants from high-deprivation neighborhoods (higher ADI, Mean ± SD: 6.93 ± 2.37) had significantly more ED visits without admission than those from less deprived areas (5.67 ± 2.86, p = 0.003). Higher COI scores, reflecting greater opportunity, were associated with fewer ED visits (p = 0.004). Medicaid was associated with lower COI/higher ADI scores (p < 0.001) and independently associated with increased ED visits (OR = 3.01, 95% CI: 1.52-5.97, p = 0.001). No significant associations were found between SDOH and pediatric pulmonology follow-up or medication prescriptions. Mediation analysis demonstrated that structural factors-ADI, COI, and insurance-mediated the relationship between race/ethnicity and hospital visits.

Conclusion: Neighborhood disadvantages, lower childhood opportunity, and Medicaid insurance were associated with greater hospital utilization. Mediation analysis revealed that these structural factors accounted for racial/ethnic differences, underscoring SDOH's role in shaping healthcare use and the importance of addressing structural inequities to promote equitable outcomes.

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支气管肺发育不良婴儿健康和医疗保健利用的社会决定因素。

背景和目的：患有支气管肺发育不良（BPD）的婴儿存在不良健康结局的高风险，然而健康的社会决定因素（SDOH）在形成差异和医疗保健利用方面的影响仍然知之甚少。本研究评估SDOH对新生儿重症监护病房出院后一年内BPD患儿医疗保健利用的影响。方法：我们对2021年1月至2023年12月间从NICU出院的161名BPD婴儿进行了回顾性研究。SDOH的主要变量包括地区剥夺指数（ADI）、儿童机会指数（COI）和保险类型。主要结局是新生儿重症监护病房出院后一年内的医疗保健利用情况，包括急诊科（ED）就诊、住院情况、儿科肺病随访和药物使用情况。结果：来自高贫困社区的婴儿（ADI较高，Mean±SD: 6.93±2.37）比来自较贫困地区的婴儿（5.67±2.86,p = 0.003）有更多的ED就诊。较高的COI分数，反映了更大的机会，与较少的ED就诊相关（p = 0.004）。医疗补助与较低的COI/较高的ADI评分相关(p结论：社区劣势、较低的儿童机会和医疗补助保险与较高的医院使用率相关。调解分析显示，这些结构性因素解释了种族/民族差异，强调了SDOH在塑造医疗保健使用方面的作用，以及解决结构性不平等以促进公平结果的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Pulmonology 医学-呼吸系统

CiteScore

6.00

自引率

12.90%

发文量

468

审稿时长

3-8 weeks

期刊介绍： Pediatric Pulmonology (PPUL) is the foremost global journal studying the respiratory system in disease and in health as it develops from intrauterine life though adolescence to adulthood. Combining explicit and informative analysis of clinical as well as basic scientific research, PPUL provides a look at the many facets of respiratory system disorders in infants and children, ranging from pathological anatomy, developmental issues, and pathophysiology to infectious disease, asthma, cystic fibrosis, and airborne toxins. Focused attention is given to the reporting of diagnostic and therapeutic methods for neonates, preschool children, and adolescents, the enduring effects of childhood respiratory diseases, and newly described infectious diseases. PPUL concentrates on subject matters of crucial interest to specialists preparing for the Pediatric Subspecialty Examinations in the United States and other countries. With its attentive coverage and extensive clinical data, this journal is a principle source for pediatricians in practice and in training and a must have for all pediatric pulmonologists.