Impact of Social Determinants on Home Oxygen Therapy Duration in Preterm Infants: A Study Utilizing the Childhood Opportunity Index.

Introduction: Recorded home oximetry (RHO) standardizes and reduces home oxygen therapy (HOT) duration in infants with post-prematurity related lung disease (PPRD). The impact of social determinants of health (SDoH) on HOT outcomes using RHO is unknown. We examined whether the childhood opportunity index (COI) and maternal race influence HOT duration in infants with PPRD using RHO.

Methods: This secondary analysis of a cohort from the RHO Implementation Study used COI determined by zip code, dichotomized as low (very low/low) and high (moderate/high/very high) opportunity. Time-to-discontinuation was stratified by COI and maternal race, estimated using Kaplan-Meier methodology. Cox regression (stratified for NICU duration by quantiles) modeled the impact of neonatal variables and COI on HOT duration.

Results: Ninety seven infants were included (34 low COI, 63 high COI). Median HOT duration was 96 days for low COI and 64 days for high COI (95% CI: 57-157; 95% CI: 52-80, p = 0.3). Longer NICU stay decreased HOT discontinuation risk (HR: 0.99, 95% CI: 0.99-1.00, p = 0.002). High COI was not associated with an increased risk of HOT discontinuation (HR: 1.44, 95% CI: 0.83-2.5, p = 0.195). Infants born to Black mothers had longer NICU stays and more often low COI, but not longer HOT use (HR: 1.49, 95% CI: 0.8-2.79, p = 0.206).

Conclusion: In a multicenter cohort of infants with PPRD discharged on HOT, low COI, and Black maternal race were not associated with an increased risk for prolonged oxygen use when following a protocoled weaning approach. Further research is needed to assess if standardized HOT management mitigates SDoH-related disparities in oxygen duration.