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

doi:10.1016/j.jpeds.2023.113443

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

Pediatrics

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English
Article number	113443
Journal	Journal of Pediatrics
DOIs	https://doi.org/10.1016/j.jpeds.2023.113443
State	Accepted/In press - 2023

Bibliographical note

Funding Information:
The National Institutes of Health , the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources , and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network’s Generic Database and Follow-up Studies through cooperative agreements. Individual site grant numbers listed in the Appendix ; available at www.jpeds.com . NICHD staff had input into the design and conduct of the study, interpretation of the data, and decision to submit the manuscript for publication. Data were collected by participating centers. Data were managed and analyzed by RTI staff. The manuscript was prepared by the authors then reviewed and approved by NICHD staff.

Publisher Copyright:
© 2023 Elsevier Inc.

Keywords

discharge
education
insurance
neurodevelopment
premature
race

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jpeds.2023.113443

Cite this

@article{ce9e6833778344daa21d61ee2335a1f6,

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

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",

author = "Brumbaugh, {Jane E.} and Vohr, {Betty R.} and Bell, {Edward F.} and Bann, {Carla M.} and Travers, {Colm P.} and McGowan, {Elisabeth C.} and Harmon, {Heidi M.} and Carlo, {Waldemar A.} and Duncan, {Andrea F.} and Hintz, {Susan R.} and Jobe, {Alan H.} and Caplan, {Michael S.} and Polin, {Richard A.} and Laptook, {Abbot R.} and Martin Keszler and Hensman, {Angelita M.} and Barbara Alksninis and Carmena Bishop and Burke, {Robert T.} and Melinda Caskey and Laurie Hoffman and Katharine Johnson and Keszler, {Mary Lenore} and Knoll, {Andrea M.} and Vita Lamberson and Leach, {Teresa M.} and Emilee Little and Stephens, {Bonnie E.} and Elisa Vieira and {St. Pierre}, Lucille and Suzy Ventura and Watson, {Victoria E.} and Hibbs, {Anna Maria} and Walsh, {Michele C.} and Wilson-Costello, {Deanne E.} and Newman, {Nancy S.} and Monika Bhola and Payne, {Allison H.} and Siner, {Bonnie S.} and Gulgun Yalcinkaya and Truog, {William E.} and Pallotto, {Eugenia K.} and Kilbride, {Howard W.} and Cheri Gauldin and Anne Holmes and Kathy Johnson and Allison Scott and Parimi, {Prabhu S.} and Lisa Gaetano and Goldstein, {Ricki F.}",

note = "Funding Information: The National Institutes of Health , the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources , and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network{\textquoteright}s Generic Database and Follow-up Studies through cooperative agreements. Individual site grant numbers listed in the Appendix ; available at www.jpeds.com . NICHD staff had input into the design and conduct of the study, interpretation of the data, and decision to submit the manuscript for publication. Data were collected by participating centers. Data were managed and analyzed by RTI staff. The manuscript was prepared by the authors then reviewed and approved by NICHD staff. Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2023",

doi = "10.1016/j.jpeds.2023.113443",

language = "English",

}

TY - JOUR

T1 - Early-Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm

AU - Brumbaugh, Jane E.

AU - Vohr, Betty R.

AU - Bell, Edward F.

AU - Bann, Carla M.

AU - Travers, Colm P.

AU - McGowan, Elisabeth C.

AU - Harmon, Heidi M.

AU - Carlo, Waldemar A.

AU - Duncan, Andrea F.

AU - Hintz, Susan R.

AU - Jobe, Alan H.

AU - Caplan, Michael S.

AU - Polin, Richard A.

AU - Laptook, Abbot R.

AU - Keszler, Martin

AU - Hensman, Angelita M.

AU - Alksninis, Barbara

AU - Bishop, Carmena

AU - Burke, Robert T.

AU - Caskey, Melinda

AU - Hoffman, Laurie

AU - Johnson, Katharine

AU - Keszler, Mary Lenore

AU - Knoll, Andrea M.

AU - Lamberson, Vita

AU - Leach, Teresa M.

AU - Little, Emilee

AU - Stephens, Bonnie E.

AU - Vieira, Elisa

AU - St. Pierre, Lucille

AU - Ventura, Suzy

AU - Watson, Victoria E.

AU - Hibbs, Anna Maria

AU - Walsh, Michele C.

AU - Wilson-Costello, Deanne E.

AU - Newman, Nancy S.

AU - Bhola, Monika

AU - Payne, Allison H.

AU - Siner, Bonnie S.

AU - Yalcinkaya, Gulgun

AU - Truog, William E.

AU - Pallotto, Eugenia K.

AU - Kilbride, Howard W.

AU - Gauldin, Cheri

AU - Holmes, Anne

AU - Johnson, Kathy

AU - Scott, Allison

AU - Parimi, Prabhu S.

AU - Gaetano, Lisa

AU - Goldstein, Ricki F.

N1 - Funding Information: The National Institutes of Health , the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources , and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network’s Generic Database and Follow-up Studies through cooperative agreements. Individual site grant numbers listed in the Appendix ; available at www.jpeds.com . NICHD staff had input into the design and conduct of the study, interpretation of the data, and decision to submit the manuscript for publication. Data were collected by participating centers. Data were managed and analyzed by RTI staff. The manuscript was prepared by the authors then reviewed and approved by NICHD staff. Publisher Copyright: © 2023 Elsevier Inc.

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - discharge

KW - education

KW - insurance

KW - neurodevelopment

KW - premature

KW - race

UR - http://www.scopus.com/inward/record.url?scp=85160068614&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85160068614&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2023.113443

DO - 10.1016/j.jpeds.2023.113443

M3 - Article

C2 - 37105408

AN - SCOPUS:85160068614

SN - 0022-3476

JO - Journal of Pediatrics

JF - Journal of Pediatrics

M1 - 113443

ER -

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this