Early life outcomes in relation to social determinants of health for children born extremely preterm
Brumbaugh, J. E., Vohr, B. R., Bell, E. F., Bann, C. M., Travers, C. P., McGowan, E. C., Harmon, H. M., Carlo, W. A., Duncan, A. F., Hintz, S. R., & EUNICE KENNEDY SHRIVER NICHD NEONATAL RESEARCH NETWORK (2023). Early life outcomes in relation to social determinants of health for children born extremely preterm. The Journal of Pediatrics, Article 113443. Advance online publication. https://doi.org/10.1016/j.jpeds.2023.113443
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' 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).
RESULTS: 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.
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 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.