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Respiratory Outcomes in Infants and Children With Bronchopulmonary Dysplasia Living in Rural Areas
Noah D Christian1, Brianna C Aoyama1, Sharon A McGrath-Morrow2
1Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Children with bronchopulmonary dysplasia (BPD) in rural areas have similar respiratory outcomes to urban counterparts. However, demographic differences and unique challenges like healthcare access require further investigation for this vulnerable population.
Area of Science:
- Pediatric Pulmonology
- Environmental Health
- Rural Health Disparities
Background:
- Bronchopulmonary dysplasia (BPD) is a primary respiratory complication in preterm infants.
- Environmental factors significantly impact BPD outcomes.
- Rural populations face distinct challenges regarding environmental exposures and access to specialized medical care.
Purpose of the Study:
- To compare respiratory outcomes in infants and children with BPD residing in rural versus urban/suburban areas.
- To analyze differences based on distance to tertiary care and population density.
- To identify potential disparities in care and outcomes for rural BPD patients.
Main Methods:
- Retrospective cohort study of 1116 subjects from an outpatient BPD Clinic (2008-2025).
- Rurality defined by distance to Johns Hopkins Children's Center (JHCC) and zip code population density.
- Data collected via chart review and caregiver questionnaires; analyzed using chi-square, t-tests, and logistic regression.
Main Results:
- 22.5% of patients resided in rural zip codes (<500 persons per square mile).
- Rural patients were more likely to be white and have private insurance.
- No significant difference in outpatient respiratory outcomes was observed between rural and urban/suburban BPD patients, though rural patients were less likely to be prescribed oral steroids.
Conclusions:
- Demographic variations exist between rural and urban/suburban BPD populations.
- Outpatient respiratory outcomes for BPD appear similar across rural and urban settings.
- Further research is needed to address environmental exposures and healthcare access for rural BPD patients.
Rationale:
Bronchopulmonary dysplasia (BPD) is the most common respiratory complication of preterm birth, and various environmental exposures have been associated with long-term outcomes. Rural patients face unique challenges with regard to their environmental exposures and distance to care.
Objective:
To assess differences in acute and chronic respiratory outcomes between infants and children with BPD residing in rural areas, as defined by distance to tertiary care and population density, and those residing in urban and suburban areas.
Methods:
A retrospective cohort study of 1116 subjects who were recruited from an outpatient BPD Clinic between January 2008 and January 2025 was performed. Data were collected through chart review and caregiver questionnaires obtained at routine clinic visits. Rurality was defined by both distance to Johns Hopkins Children's Center (JHCC) in miles as well as population density in persons per square mile (ppsm) of an individual's home zip code. Data were analyzed using chi-square, t-tests, and logistic regression.
Results:
22.5% of the study population lived in rural zip codes with < 500 ppsm. Rural patients were more likely to be white and have private health insurance. When comparing clinical outcomes, patients living in rural areas were less likely to be prescribed oral steroids compared to those living in suburban or urban settings.
Conclusions:
Although there are demographic differences between those living in rural versus urban or suburban settings, outpatient respiratory outcomes are similar. Further work should explore specific environmental exposures and health care access issues that affect the rural population with BPD.
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