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Published on: November 20, 2015
Socio-economic factors and outcomes in chronic lung disease of prematurity
J Michael Collaco1, SeEun Jennifer Choi, Kristin A Riekert
1Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, 200 North Wolfe Street, Baltimore, MD 21287, USA. mcollac1@jhmi.edu
Insights
Non-White infants with chronic lung disease of prematurity were more likely to use rescue medications and systemic steroids. However, no disparities in care were found for major therapy decisions in this vulnerable population.
Area of Science:
- Pediatrics
- Neonatology
- Pulmonology
Background:
- Infants and children with chronic lung disease of prematurity (CLDP) face heightened risks of respiratory complications.
- Socioeconomic status, race/ethnicity, and sex may influence these morbidities and healthcare access.
- Understanding potential disparities in care for CLDP is crucial for equitable treatment.
Purpose of the Study:
- To investigate if socioeconomic status, race/ethnicity, or sex are risk factors for respiratory morbidities in CLDP.
- To determine if disparities in major therapy decisions exist for CLDP patients.
- To analyze differences in neonatal intensive care unit (NICU) length of stay.
Main Methods:
- A cohort of premature infants (<32 weeks gestation) with CLDP was studied between January 2008 and February 2010.
- Sociodemographic and respiratory morbidity data were collected for children under 3 years old.
- Adjusted regression models assessed associations between risk factors and respiratory morbidities/treatment parameters.
Main Results:
- Non-White subjects reported higher use of rescue medications and systemic steroids for respiratory symptoms.
- Lower household income correlated with increased activity limitations.
- Public insurance was linked to a reduced risk of hospitalizations.
- No disparities in major therapy decisions (home oxygen, gastrostomy tubes) were identified.
Conclusions:
- Non-White children with CLDP showed increased use of certain respiratory medications compared to White children.
- Despite medication use differences, no disparities in respiratory symptoms or preventative inhaled corticosteroid use were observed.
- Further research is needed to understand the underlying causes of these observed medication use patterns.
Rationale:
Infants and children with chronic lung disease of prematurity (CLDP) are at increased risk for respiratory morbidities. We sought to determine (1) whether socio-economic status, race/ethnicity, and/or sex are risk factors for respiratory morbidities and (2) whether disparities in care existed for major therapy decisions such as home supplemental oxygen and gastrostomy tubes as well as initial length of stay in the neonatal intensive care unit.
Methods:
Between January 2008 and February 2010 sociodemographic and respiratory morbidity data were collected on premature (<32 weeks gestation) infants and children (<3 years old) with CLDP. Associations between risk factors and respiratory morbidities and treatment parameters were examined using adjusted regression models.
Results:
Data were collected on 135 subjects (gestational age: 26.2±2.0 weeks). Self-reported non-Whites were more likely to report rescue medication use in the past 7 days [adjusted OR: 2.87 (1.28-6.45), P=0.011] and the use of systemic steroids for respiratory symptoms since the last clinic visit [adjusted OR: 2.12 (1.02-4.43), P=0.045]. Lower median household income was associated with increased activity limitations [adjusted OR: 2.79 (1.16-6.70), P=0.022] and public insurance coverage was associated with a decreased risk for hospitalizations [adjusted OR: 0.36 (0.13-0.98), P=0.045]. Major therapy decisions were not associated with disparities of care.
Conclusions:
A key finding was that non-Whites were more likely to report rescue medication and systemic steroid use than Whites, but there was no difference in the frequency of respiratory symptoms or preventative inhaled corticosteroid use. Etiologies for these findings remain unclear and require further research.
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