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. 2023 Aug:259:113443.
doi: 10.1016/j.jpeds.2023.113443. Epub 2023 Apr 25.

Early-Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm

Jane E Brumbaugh  1 , Betty R Vohr  2 , Edward F Bell  3 , Carla M Bann  4 , Colm P Travers  5 , Elisabeth C McGowan  2 , Heidi M Harmon  3 , Waldemar A Carlo  5 , Andrea F Duncan  6 , Susan R Hintz  7 ; Eunice Kennedy Shriver NICHD Neonatal Research Network
Collaborators, Affiliations

Early-Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm

Jane E Brumbaugh et al. J Pediatr. 2023 Aug.

Abstract

Objective: To characterize the relationships between social determinants of health (SDOH) and outcomes for children born extremely preterm.

Study design: This is a cohort study of infants born at 22-26 weeks of gestation in National Institute of Child Health and Human Development Neonatal Research Network centers (2006-2017) who survived to discharge. Infants were classified by 3 maternal SDOH: education, insurance, and race. Outcomes included postmenstrual age (PMA) at discharge, readmission, neurodevelopmental impairment (NDI), and death postdischarge. Regression analyses adjusted for center, perinatal characteristics, neonatal morbidity, ethnicity, and 2 SDOH (eg, group comparisons by education adjusted for insurance and race).

Results: Of 7438 children, 5442 (73%) had at least 1 risk-associated SDOH. PMA at discharge was older (adjusted mean difference 0.37 weeks, 95% CL 0.06, 0.68) and readmission more likely (aOR 1.27, 95% CL 1.12, 1.43) for infants whose mothers had public/no insurance vs private. Neither PMA at discharge nor readmission varied by education or race. NDI was twice as likely (aOR 2.36, 95% CL 1.86, 3.00) and death 5 times as likely (aOR 5.22, 95% CL 2.54, 10.73) for infants with 3 risk-associated SDOH compared with those with none.

Conclusions: Children born to mothers with public/no insurance were older at discharge and more likely to be readmitted than those born to privately insured mothers. NDI and death postdischarge were more common among children exposed to multiple risk-associated SDOH at birth compared with those not exposed. Addressing disparities due to maternal education, insurance coverage, and systemic racism are potential intervention targets to improve outcomes for children born preterm.

Keywords: discharge; education; insurance; neurodevelopment; premature; race.

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Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to disclose.

Figures

Figure 1 (Online).
Figure 1 (Online).
Flow diagram showing subject classification by the presence or absence of maternal social determinants of health associated with risk. a. More than one exclusion criterion may be present. b. SDOH, social determinant(s) of health; more than one risk-associated social determinant of health may be present.
Figure 2.
Figure 2.
Forest plots of the regression analyses for highlighted categorical outcomes by social determinants of health at birth.
See this image and copyright information in PMC

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