Social Determinants of Health and Healthcare Utilization in Infants With Bronchopulmonary Dysplasia
Haley Urbach1, Sharon Ostfeld-Johns2,3, Sarah McCollum1
1Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, Connecticut, USA.
Insights
Social determinants of health like neighborhood disadvantage and Medicaid insurance increase hospital visits for infants with bronchopulmonary dysplasia (BPD). These factors also explain racial disparities in healthcare use.
Area of Science:
- Pediatric Health
- Health Services Research
- Social Epidemiology
Background:
- Infants with bronchopulmonary dysplasia (BPD) face significant health risks.
- Understanding how social determinants of health (SDOH) influence their healthcare utilization is crucial for addressing disparities.
Purpose of the Study:
- To evaluate the impact of SDOH on healthcare utilization in infants with BPD during their first year post-NICU discharge.
- To identify specific SDOH factors contributing to disparities in care.
Main Methods:
- Retrospective study of 161 infants with BPD post-NICU discharge (2021-2023).
- Key SDOH variables: Area Deprivation Index (ADI), Childhood Opportunity Index (COI), insurance type.
- Outcomes: emergency department (ED) visits, hospital admissions, pulmonology follow-up, medication use.
Main Results:
- Higher neighborhood deprivation (ADI) and lower childhood opportunity (COI) were linked to increased ED visits.
- Medicaid insurance was associated with higher ADI/lower COI and independently predicted more ED visits.
- Structural factors (ADI, COI, insurance) mediated racial/ethnic differences in hospital visits.
Conclusions:
- Neighborhood disadvantage, lower childhood opportunity, and Medicaid insurance correlate with increased hospital utilization in infants with BPD.
- These structural SDOH factors explain observed racial/ethnic disparities in healthcare use.
- Addressing structural inequities is vital for promoting equitable health outcomes for infants with BPD.
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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