Area Deprivation and Respiratory Morbidities in Children with
Bronchopulmonary Dysplasia
Abstract
Introduction: Infants and children diagnosed with BPD have a higher
likelihood of recurrent hospitalizations and asthma-like symptoms.
Socio-environmental factors that influence frequency and severity of
pulmonary symptoms in these children during the pre-school age are
poorly under-stood. In this study, we used the Area Deprivation Index
(ADI) to evaluate the relationship between the socio-environmental
exposures in children with BPD and respiratory outcomes during the first
few years of life. Methods: A registry of subjects recruited from
outpatient BPD clinics at Johns Hopkins University (n=909) and the
Children’s Hospital of Philadelphia (n=125) between January 2008 and
October 2021 was used. Subjects were separated into tertiles by ADI
scores aggregated to ZIP codes. Care-giver questionnaires were used to
assess the frequency of respiratory morbidities and acute care usage for
respiratory symptoms. Results: The mean gestational age of subjects was
26.8±2.6 weeks with a mean birthweight of 909±404 grams. The highest
tertile (most deprived) of ADI was significantly associated with
emer-gency department visits (aOR 1.72; p=0.009), hospital readmissions
(aOR 1.66; p=0.030), and activi-ty limitations (aOR 1.55; p=0.048)
compared to the lowest tertile. No association was seen with steroid,
antibiotic or rescue medication use, trouble breathing, or nighttime
symptoms. Conclusion: In this study, children with BPD who lived in
neighborhoods of higher deprivation were more likely to be
re-hospitalized and have ED visits for respiratory reasons. Identifying
socio-environmental factors that contribute to adverse pulmonary
outcomes in children with BPD may provide opportunities for earlier
interventions to improve long-term pulmonary outcomes.