Journal article
Early Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm
The Journal of pediatrics, Vol.259, 113443
08/2023
DOI: 10.1016/j.jpeds.2023.113443
PMCID: PMC10468025
PMID: 37105408
Abstract
To characterize the relationships between social determinants of health (SDOH) and outcomes for children born extremely preterm.
This is a cohort study of infants born at 22-26 weeks' gestation in NICHD Neonatal Research Network centers (2006-2017) who survived to discharge. Infants were classified by three maternal SDOH: education, insurance, and race. Outcomes included postmenstrual age (PMA) at discharge, readmission, neurodevelopmental impairment (NDI), and death post-discharge. Regression analyses adjusted for center, perinatal characteristics, neonatal morbidity, ethnicity, and two SDOH (eg, group comparisons by education adjusted for insurance and race).
Of 7438 children, 5442 (73%) had at least one risk-associated SDOH. PMA at discharge was older (adjusted mean difference 0.37 weeks, 95% confidence interval (CI) 0.06-0.68) and readmission more likely (adjusted odds ratio (aOR) 1.27, 95% CI 1.12-1.43) for infants whose mothers had public/no insurance versus private. Neither PMA at discharge nor readmission varied by education or race. NDI was twice as likely (aOR 2.36, 95% CI 1.86-3.00) and death five times as likely (aOR 5.22, 95% CI 2.54-10.73) for infants with three risk-associated SDOH compared with those with none.
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 post-discharge 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.
Details
- Title: Subtitle
- Early Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm
- Creators
- Jane E BrumbaughBetty R Vohr - Brown UniversityEdward F Bell - University of IowaCarla M Bann - RTI InternationalColm P Travers - University of Alabama at BirminghamElisabeth C McGowan - Brown UniversityHeidi M Harmon - University of IowaWaldemar A Carlo - University of Alabama at BirminghamAndrea F Duncan - University of PennsylvaniaSusan R Hintz - Stanford University School of MedicineEunice Kennedy Shriver NICHD Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.259, 113443
- DOI
- 10.1016/j.jpeds.2023.113443
- PMID
- 37105408
- PMCID
- PMC10468025
- NLM abbreviation
- J Pediatr
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Grant note
- DOI: 10.13039/100000097, name: National Center for Research Resources; DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences; DOI: 10.13039/100009633, name: Eunice Kennedy Shriver National Institute of Child Health and Human Development; DOI: 10.13039/100000002, name: National Institutes of Health
- Language
- English
- Electronic publication date
- 04/25/2023
- Date published
- 08/2023
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984399641502771
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