449 - Neighborhood social vulnerability, emergency department visits, and hospital readmissions in infants with bronchopulmonary dysplasia (BPD)

Poster Number: 449
Publication Number: 449.431

Timothy D. Nelin, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Nancy Yang, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Scott A. Lorch, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Sara B. DeMauro, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Nicolas A. Bamat, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Erik A. Jensen, Children's Hospital of Philadelphia, haddonfield, NJ, United States; Kathleen Gibbs, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Allan C. Just, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Heather Burris, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Preterm infants with BPD are at risk for adverse health outcomes after discharge. Whether neighborhood factors affect healthcare utilization in infants with BPD is unknown.

Objective: To quantify the association of the CDC Social Vulnerability Index (SVI) at the census tract level with acute respiratory illness in the first year after NICU discharge in infants with BPD.

Design/Methods: We generated a dataset comprising infants with BPD from a local research registry and the Children’s Hospital of Philadelphia electronic health record. Included infants were born < 32 weeks gestation (GA) between 2010-2020 and met criteria for BPD at 36 weeks post-menstrual age. We geocoded each patient’s address at hospital discharge to assign a CDC SVI value from 2018. SVI includes 15 social factors (e.g., census tract poverty, education, household structure, demographics, housing & transportation) and ranges from 0-1; higher SVI values indicate more vulnerability. Logistic regression models including census track as a random effect were used to quantify associations of SVI with the primary outcome of acute respiratory illness defined as an ED visit or readmission in the first year after NICU discharge, adjusting for GA, sex, birth year, respiratory support at 36 weeks, race, ethnicity, and insurance. A secondary analysis restricted to metro Philadelphia was performed.

Results: 540 infants met inclusion criteria. Figure 1 displays SVI in metro Philadelphia. Table 1 shows bivariate associations of characteristics and SVI with acute respiratory illness. Per standard deviation increment increase in SVI, infants had higher odds of acute respiratory illness in unadjusted (OR 1.48, 95%CI: 1.22-1.79) and adjusted models for GA, sex, birth year, and respiratory support at 36 weeks (aOR 1.51, 95%CI: 1.24-1.84)(Table 2). Further adjustment for patient race, ethnicity, and insurance attenuated the association (aOR 1.18, 95%CI: 0.93-1.49). Results were similar when restricted to metro Philadelphia.Conclusion(s): In preterm infants with BPD, census tract SVI was associated with an ED visit or hospital admission in the year after NICU discharge in models adjusted for severity of illness. However, this association may be driven by insurance and other factors associated with race and ethnicity. Larger studies from broader geographic regions are required to clarify the relationship between SVI and healthcare utilization in patients with BPD.
CVCV_TimothyNelin.pdf
Table 1. Bivariate associations of cohort characteristics with acute respiratory illness (ED visit or hospital readmission) among infants with BPD.Table depicts infants readmitted for respiratory distress to CHOP in the first year after NICU discharge. Two-way t-test used for continuous variables. Chi-square used for categorical variables.
*BPD Grade stratified at 36 weeks or hospital admission if hospital admission to CHOP occurred after 36 weeks post menstrual age using Jensen criteria (AJRCCM 2019).
Missing data: birth weight (n = 7).