Association of socioeconomic status with development and severity of necrotizing enterocolitis

Necrotizing enterocolitis (NEC) commonly afflicts premature infants. Prematurity is associated with lower socioeconomic status (SES); however, it is unclear whether lower SES is independently associated with NEC development or severity of NEC.

The Pediatric Health Information System (PHIS) database was used to identify infants ≤60 days old with NEC from 2016 to 2023. Infants with NEC were 1:1 matched with non-NEC controls based on gestational age, chronological age, race/ethnicity, and cardiac disease. SES was measured using median household income (MHI) by zip code and Child Opportunity Index (COI). Multivariable logistic regression models measured associations with SES, and mediation analysis assessed the extent of this association mediated by prematurity.

11,181 infants with NEC were identified. NEC patients were from lower SES areas as indicated by both MHI and COI (p < 0.0001 for both comparisons). In the case-control study, conditional logistic regression found that lower MHI and lower COI were significantly associated with NEC when adjusting for other factors. The associations between NEC and SES were similar when using multivariable logistic regression modeling on the entire cohort. Furthermore, prematurity mediated only 29.2 % and 27.5 % of the association between NEC and MHI and COI, respectively. Among infants with NEC, MHI and COI were not consistently associated with the need for surgical intervention.

Lower SES is an important risk factor for developing NEC. This association is beyond that which is simply mediated by prematurity. Targeted interventions supporting low-SES families may reduce NEC disease burden.

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