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Sociodemographic factors associated with tracheostomy and mortality in bronchopulmonary dysplasia
Michael A Smith1, Martina A Steurer1,2,3, Malini Mahendra1,4
1Department of Pediatrics, Division of Critical Care Medicine, School of Medicine, University of California, San Francisco, California, USA.
Insights
Racial and ethnic disparities exist in tracheostomy insertion for infants with bronchopulmonary dysplasia (BPD), unrelated to socioeconomic status. Post-tracheostomy mortality did not show similar disparities.
Area of Science:
- Neonatal Medicine
- Public Health
- Health Disparities
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in premature infants.
- Tracheostomy is a procedure sometimes required for infants with severe BPD to aid breathing.
- Understanding factors influencing tracheostomy rates and outcomes is crucial for equitable care.
Purpose of the Study:
- To examine the relationship between race, ethnicity, socioeconomic status, and tracheostomy insertion in infants with BPD.
- To investigate the association between these factors and post-tracheostomy mortality.
Main Methods:
- Utilized the Vizient Clinical Database/Resource Manager for infant data (born ≤32 weeks with BPD, 2012-2020).
- Linked socioeconomic status data from the Agency for Healthcare Research and Quality.
- Employed regression models to analyze tracheostomy insertion rates and mortality, adjusting for covariates.
Main Results:
- Among 40,021 infants, 4.0% received a tracheostomy; rates varied annually.
- Non-Hispanic Black infants had higher odds of tracheostomy insertion (aOR 1.25), while Hispanic infants had lower odds (aOR 0.80) compared to non-Hispanic White infants.
- Public insurance was linked to increased tracheostomy odds, but other socioeconomic factors were not significant. In-hospital mortality was 14.1% and not sociodemographically linked.
Conclusions:
- Significant racial and ethnic disparities in tracheostomy insertion for BPD infants exist.
- These disparities are not explained by socioeconomic status or neonatal comorbidities.
- Further research is required to identify the origins and mitigation strategies for these disparities.
Objectives:
We sought to investigate how race, ethnicity, and socioeconomic status relate to tracheostomy insertion and post-tracheostomy mortality among infants with bronchopulmonary dysplasia (BPD).
Methods:
The Vizient Clinical Database/Resource Manager was queried to identify infants born ≤32 weeks with BPD admitted to US hospitals from January 2012 to December 2020. Markers of socioeconomic status were linked to patient records from the Agency for Healthcare Research and Quality's Social Determinants of Health Database. Regression models were used to assess trends in annual tracheostomy insertion rate and odds of tracheostomy insertion and post-tracheostomy mortality, adjusting for sociodemographic and clinical factors.
Results:
There were 40,021 ex-premature infants included in the study, 1614 (4.0%) of whom received a tracheostomy. Tracheostomy insertion increased from 2012 to 2017 (3.1%-4.1%), but decreased from 2018 to 2020 (3.3%-1.6%). Non-Hispanic Black infants demonstrated a 25% higher odds (aOR 1.25, 1.09-1.43) and Hispanic infants demonstrated a 20% lower odds (aOR 0.80, 0.65-0.96) of tracheostomy insertion compared with non-Hispanic White infants. Patients receiving public insurance had increased odds of tracheostomy insertion (aOR 1.15, 1.03-1.30), but there was no relation between other metrics of socioeconomic status and tracheostomy insertion within our cohort. In-hospital mortality among the tracheostomy-dependent was 14.1% and was not associated with sociodemographic factors.
Conclusions:
Disparities in tracheostomy insertion are not accounted for by differences in socioeconomic status or the presence of additional neonatal morbidities. Post-tracheostomy mortality does not demonstrate the same relationships. Further investigation is needed to explore the source and potential mitigators of the identified disparities.
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