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.