Volume 60, Issue 6 e71153

ORIGINAL ARTICLE

Social Determinants of Health and Healthcare Utilization in Infants With Bronchopulmonary Dysplasia

Haley Urbach,

Haley Urbach

orcid.org/0000-0003-3820-3578

Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, Connecticut, USA

Contribution: Data curation, Validation, Writing - original draft, Writing - review & editing

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Sharon Ostfeld-Johns,

Sharon Ostfeld-Johns

Department of Internal Medicine, Section of General Internal Medicine, Program for Hospital Medicine, Yale University, New Haven, Connecticut, USA

Department of Pediatrics, Section of Hospital Medicine, Yale University, New Haven, Connecticut, USA

Contribution: Writing - original draft, Writing - review & editing, Methodology, Supervision

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Sarah McCollum,

Sarah McCollum

Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, Connecticut, USA

Contribution: Methodology, Validation, Writing - review & editing

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Pnina Weiss,

Pnina Weiss

orcid.org/0000-0001-7217-0605

Department of Pediatrics, Section of Pulmonary, Allergy-Immunology, and Sleep Medicine, Yale University, New Haven, Connecticut, USA

Contribution: Writing - review & editing, Supervision

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Sarah Kandil,

Sarah Kandil

orcid.org/0000-0002-2618-2119

Department of Pediatrics, Section of Critical Care Medicine, Yale University, New Haven, Connecticut, USA

Contribution: Supervision, Writing - review & editing

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Eliaz Brumer,

Corresponding Author

Eliaz Brumer

[email protected]

orcid.org/0000-0002-0604-8668

Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, Connecticut, USA

Department of Pediatrics, Section of Pulmonary, Allergy-Immunology, and Sleep Medicine, Yale University, New Haven, Connecticut, USA

Correspondence: Eliaz Brumer ([email protected])

Contribution: Conceptualization, Writing - original draft, Methodology, Validation, Writing - review & editing, Formal analysis, Data curation

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Haley Urbach,

Haley Urbach

orcid.org/0000-0003-3820-3578

Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, Connecticut, USA

Contribution: Data curation, Validation, Writing - original draft, Writing - review & editing

Search for more papers by this author

Sharon Ostfeld-Johns,

Sharon Ostfeld-Johns

Department of Internal Medicine, Section of General Internal Medicine, Program for Hospital Medicine, Yale University, New Haven, Connecticut, USA

Department of Pediatrics, Section of Hospital Medicine, Yale University, New Haven, Connecticut, USA

Contribution: Writing - original draft, Writing - review & editing, Methodology, Supervision

Search for more papers by this author

Sarah McCollum,

Sarah McCollum

Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, Connecticut, USA

Contribution: Methodology, Validation, Writing - review & editing

Search for more papers by this author

Pnina Weiss,

Pnina Weiss

orcid.org/0000-0001-7217-0605

Department of Pediatrics, Section of Pulmonary, Allergy-Immunology, and Sleep Medicine, Yale University, New Haven, Connecticut, USA

Contribution: Writing - review & editing, Supervision

Search for more papers by this author

Sarah Kandil,

Sarah Kandil

orcid.org/0000-0002-2618-2119

Department of Pediatrics, Section of Critical Care Medicine, Yale University, New Haven, Connecticut, USA

Contribution: Supervision, Writing - review & editing

Search for more papers by this author

Eliaz Brumer,

Corresponding Author

Eliaz Brumer

[email protected]

orcid.org/0000-0002-0604-8668

Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, Connecticut, USA

Department of Pediatrics, Section of Pulmonary, Allergy-Immunology, and Sleep Medicine, Yale University, New Haven, Connecticut, USA

Correspondence: Eliaz Brumer ([email protected])

Contribution: Conceptualization, Writing - original draft, Methodology, Validation, Writing - review & editing, Formal analysis, Data curation

Search for more papers by this author

First published: 12 June 2025

https://doi.org/10.1002/ppul.71153

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ABSTRACT

Background and Objectives

Infants with bronchopulmonary dysplasia (BPD) are at high risk for adverse health outcomes, yet the influence of social determinants of health (SDOH) in shaping disparities and healthcare utilization remains poorly understood. This study evaluates the impact of SDOH on healthcare utilization in infants with BPD during the first-year post NICU discharge.

Methods

We conducted a retrospective study of 161 infants with BPD discharged from the NICU between January 2021 and December 2023. Key SDOH variables included the Area Deprivation Index (ADI), Childhood Opportunity Index (COI), and insurance type. Primary outcomes were healthcare utilization within the first year after NICU discharge, including emergency department (ED) visits, hospital admissions, pediatric pulmonology follow-up, and medication use.

Results

Infants from high-deprivation neighborhoods (higher ADI, Mean ± SD: 6.93 ± 2.37) had significantly more ED visits without admission than those from less deprived areas (5.67 ± 2.86, p = 0.003). Higher COI scores, reflecting greater opportunity, were associated with fewer ED visits (p = 0.004). Medicaid was associated with lower COI/higher ADI scores (p < 0.001) and independently associated with increased ED visits (OR = 3.01, 95% CI: 1.52–5.97, p = 0.001). No significant associations were found between SDOH and pediatric pulmonology follow-up or medication prescriptions. Mediation analysis demonstrated that structural factors—ADI, COI, and insurance—mediated the relationship between race/ethnicity and hospital visits.

Conclusion

Neighborhood disadvantages, lower childhood opportunity, and Medicaid insurance were associated with greater hospital utilization. Mediation analysis revealed that these structural factors accounted for racial/ethnic differences, underscoring SDOH's role in shaping healthcare use and the importance of addressing structural inequities to promote equitable outcomes.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The authors have nothing to report.

Supporting Information

Filename	Description
ppul71153-sup-0001-R_Supplemental_Table_1.xlsx13.1 KB	Supplemental Table 1: Demographic and Clinical Characteristics of Infants with BPD by mutually exclusive race/ethnicity. This classification excluded 13 patients with missing or unlisted race/ethnicity information and reclassified 21 patients previously identified by race alone (4 Black and 17 white) into the Hispanic category. ED - Emergency Department, ICS - Inhaled Corticosteroids, NICU - Neonatal Intensive Care Unit.
ppul71153-sup-0002-R_Supplemental_Table_2.xlsx15.3 KB	Supplemental Table 2: Multivariable Logistic Regression Analysis of Sociodemographic Predictors of Healthcare Utilization in the First Year Post-NICU Discharge, Adjusted for Race/Mutually exclusive Race/Ethnicity groups. ADI - Area deprivation index, state normed, deciles from 1 to 10 from lowest to highest level of “disadvantage”. COI - Child Opportunity Scores, state normed, Scores from 1 to 100 (low to high opportunity). COI_SE - Child Opportunity Scores, Social and Economic domain, nationally normed, Scores from 1 to 100 for the Social and Economic domain (low to high opportunity).
ppul71153-sup-0003-R_Supplemental_Table_3.xlsx15.1 KB	Supplemental Table 3: Binary Logistic Regression Analysis of Insurance and Healthcare Utilization in the First Year Post-NICU Discharge, Adjusted for Race, Ethnicity, GA Group, BPD Severity, Pulmonology Follow-up, and Social Determinants of Health (ADI/COI). ADI - Area deprivation index, state normed, deciles from 1 to 10 from lowest to highest level of “disadvantage”. COI - Child Opportunity Scores, state normed, Scores from 1 to 100 (low to high opportunity). COI_SE - Child Opportunity Scores, social and economic domain, nationally normed, Scores from 1 to 100 for the Social and Economic domain (low to high opportunity). * One patient was missing ADI data and was excluded from all ADI-related analyses.
ppul71153-sup-0004-R_Supplemental_Table_4.xlsx15.1 KB	Supplemental Table 4: Multivariable Logistic Regression Analysis of Sociodemographic Predictors of Healthcare Utilization in the First Year Post-NICU Discharge, Adjusted for Race, Ethnicity, GA Group, BPD Severity, Pediatric Pulmonology Follow-up, and Insurance. ADI - Area deprivation index, state normed, deciles from 1 to 10 from lowest to highest level of “disadvantage”. COI - Child Opportunity Scores, state normed, Scores from 1 to 100 (low to high opportunity). *One patient was missing ADI data and was excluded from all ADI-related analyses.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Volume60, Issue6

June 2025

e71153

Social Determinants of Health and Healthcare Utilization in Infants With Bronchopulmonary Dysplasia

ABSTRACT

Background and Objectives

Methods

Results

Conclusion

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Information

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Social Determinants of Health and Healthcare Utilization in Infants With Bronchopulmonary Dysplasia

ABSTRACT

Background and Objectives

Methods

Results

Conclusion

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

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