RESULTS
Study population: Demographic and clinical characteristics for
the study population (n=1034) are described in Table 1 . The
study population was 43.1% female, 62.8% self-identified as non-White,
and 5.5% self-identified as Hispanic. Mean gestational age at birth was
26.8±2.6 weeks, and mean birth weight was 909±403 grams. More than half
(53.4%) of the subjects were classified as having severe BPD, 33.4%
moderate BPD, and 13.2% mild BPD. ZIP code ADI scores ranged from 5.5
to 93, with a mean of 42.4. There were differences in race, public
insurance, gestational age, and birth weight by ADI scores. Subjects in
the third ADI tertile (high deprivation) were more likely to be
non-White (p <0.001) and have public insurance
(p <0.001) than subjects in the first ADI tertile (low
deprivation). Subjects in the most deprived ADI tertile also had earlier
gestational age (p <0.001) and lower birth weight
(p =0.007) than counterparts in the least deprived ADI tertile,
but did not have later discharge ages (p =0.12). The difference in
birth weight by area deprivation may be attributable to the difference
in gestational age, as birth weight percentiles did not significantly
differ between ADI tertiles (p =0.49). No differences were seen
between the first and third ADI tertiles in terms of sex, ethnicity,
birth weight percentile, BPD severity, and clinical characteristics at
the time of NICU discharge, including home oxygen use, tracheostomy,
home ventilator use, inhaled corticosteroid use, pulmonary hypertension,
gastrostomy tube placement, and Nissen fundoplication. In terms of
center differences, subjects receiving care at Johns Hopkins University
had a lower median ADI (41.5±18.6) compared to subjects receiving care
at Children’s Hospital of Philadelphia (48.5±24.2;p <0.001), but the distribution of individuals in
tertiles by center was not different (p =0.06).
Clinical Outcomes: Data were collected from a total of 1800
caregiver questionnaires that surveyed subjects’ needs for acute care
for respiratory issues and their chronic symptoms. Logistic regression
mixed models were used to determine the odds ratio of adverse outcomes
for the most deprived versus the least deprived ADI tertiles, adjusting
for age at outcome data collection, race, insurance type, and
gestational age (Table 2 ). Models were nested by center to
account for center-level differences. Higher neighborhood deprivation
was significantly associated with emergency department visits (aOR 1.72;p =0.009), hospital readmissions (aOR 1.66; p =0.030), and
activity limitations (aOR 1.55; p =0.048). No association was seen
with steroid, antibiotic or rescue medication use, trouble breathing, or
nighttime symptoms.
Sensitivity Analyses: Sensitivity analyses were carried using
ZIP code mean ADI rather than median ADI. Similar to before, subjects
receiving care at Johns Hopkins University had a lower mean ADI
(42.0±17.6) compared to subjects receiving care at Children’s Hospital
of Philadelphia (48.2±21.8; p <0.001), but the
distribution of individuals in tertiles by center was not different
(p =0.11). Results were similar overall, except a difference in
discharge age and no difference in activity limitations between the
first and third ADI tertiles (Supplemental Tables 1 and 2,
respectively).