Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Associations of neighborhood social vulnerability with emergency department visits and readmissions among infants with bronchopulmonary dysplasia

Journal of Perinatology volume 43, pages 1308–1313 (2023)Cite this article

Subjects

Abstract

Objectives

To characterize associations of the CDC Social Vulnerability Index (SVI) with medically attended acute respiratory illness among infants with bronchopulmonary dysplasia (BPD).

Study design

Retrospective cohort of 378 preterm infants with BPD from a single center. Multivariable logistic regression quantified associations of SVI with medically attended acute respiratory illness, defined as emergency department (ED) visits or hospital readmissions within a year after first hospital discharge. Mediation analysis quantified the extent to which differences in SVI may explain known Black-White disparities in medically attended acute respiratory illness.

Results

SVI was associated with medically attended respiratory illness (per SVI standard deviation increment, aOR 1.44, 95% CI: 1.17–1.78). Adjustment for race and ethnicity attenuated the association (aOR 1.27, 95% CI: 0.97–1.64). SVI significantly mediated 31% of the Black-White disparity in ED visits (p = 0.04).

Conclusions

SVI was associated with, and may partially explain racial disparities in, medically attended acute respiratory illness among infants with BPD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flowchart of cohort generation.
Fig. 2: Social Vulnerability Index (SVI) and medically attended acute respiratory illness for metropolitan Philadelphia in 2018.
Fig. 3: Patient density in the metropolitan Philadelphia region by discharge address.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. The code is available at: https://github.com/tnelin/SVI.

References

  1. Doyle LW, Anderson PJ. Long-term outcomes of bronchopulmonary dysplasia. Semin Fetal Neonatal Med. 2009;14. https://doi.org/10.1016/j.siny.2009.08.004.

  2. Jones MH, Stein RT. Long-term respiratory outcomes of premature infants. Pediatr Pulmonol. 2019;54. https://doi.org/10.1002/ppul.24371.

  3. Bhandari A, Panitch HB. Pulmonary outcomes in bronchopulmonary dysplasia. Semin Perinatol. 2006;30. https://doi.org/10.1053/j.semperi.2006.05.009.

  4. Wah K, Lau WYW, Lee SL, Ng DKK. Pulmonary sequelae in long-term survivors of bronchopulmonary dysplasia. Pediatr Int. 2000;42. https://doi.org/10.1046/j.1442-200X.2000.01314.x.

  5. Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018;172. https://doi.org/10.1001/jamapediatrics.2018.2029.

  6. Karvonen KL, Baer RJ, Rogers EE, Steurer MA, Ryckman KK, Feuer SK et al. Racial and ethnic disparities in outcomes through 1 year of life in infants born prematurely: a population based study in California. J Perinatol. 2021. https://doi.org/10.1038/s41372-021-00919-9.

  7. Rice JL, McGrath-Morrow SA, Collaco JM. Indoor air pollution sources and respiratory symptoms in bronchopulmonary dysplasia. J Pediatr. 2020;222. https://doi.org/10.1016/j.jpeds.2020.03.010.

  8. Martinez S, Garcia-Meric P, Millet V, Aymeric-Ponsonnet M, Alagha K, Dubus JC. Tobacco smoke in infants with bronchopulmonary dysplasia. Eur J Pediatr. 2015;174. https://doi.org/10.1007/s00431-015-2491-y.

  9. Centers for Disease Control and Prevention (CDC). Geospatial Research A& SP (GRASP). CDC’s Social Vulnerability Index (SVI) 2016 Documentation. (2018). p. 1–24. Available at: https://svi.cdc.gov/data-and-toolsdownload.html.

  10. US Census Bureau Resource Library. https://www.census.gov/library/stories/2020/09/poverty-rates-for-blacks-and-hispanics-reached-historic-lows-in-2019.html.

  11. Collaco JM, Morrow M, Rice JL, McGrath-Morrow SA. Impact of road proximity on infants and children with bronchopulmonary dysplasia. Pediatr Pulmonol. 2020;55. https://doi.org/10.1002/ppul.24594.

  12. Deschamps J, Boucekine M, Fayol L, Dubus JC, Nauleau S, Garcia P et al. Neighborhood disadvantage and early respiratory outcomes in very preterm infants with bronchopulmonary dysplasia. J Pediatr. 2021;237. https://doi.org/10.1016/j.jpeds.2021.06.061.

  13. Emma Banwell JMCGROJLRLDJLRYSAM-M. Area deprivation and respiratory morbidities in children with bronchopulmonary dysplasia. Pediatr Pulmonol. 2022;57:2053–29.

    Article  Google Scholar 

  14. Dysart K, Gantz MG, McDonald S, Bamat NA, Keszler M, Kirpalani H et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants an evidence-based approach. Am J Respir Crit Care Med. 2019. https://doi.org/10.1164/rccm.201812-2348OC.

  15. Derakhshan S, Emrich CT, Cutter SL. Degree and direction of overlap between social vulnerability and community resilience measurements. PLoS One. 2022;17. https://doi.org/10.1371/journal.pone.0275975.

  16. Valeri L, VanderWeele TJ. Mediation analysis allowing for exposure-mediator interactions and causal interpretation: theoretical assumptions and implementation with SAS and SPSS macros. Psychol Methods. 2013;18. https://doi.org/10.1037/a0031034.

  17. Smith VC, Zupancic JAF, McCormick MC, Croen LA, Greene J, Escobar GJ et al. Rehospitalization in the first year of life among infants with bronchopulmonary dysplasia. J Pediatr. 2004;144. https://doi.org/10.1016/j.jpeds.2004.03.026.

  18. Hannan KE, Hwang SS, Bourque SL. Readmissions among NICU graduates: who, when and why? Semin Perinatol. 2020;44. https://doi.org/10.1016/j.semperi.2020.151245.

  19. Laugier O, Garcia P, Boucékine M, Daguzan A, Tardieu S, Sambuc R et al. Influence of socioeconomic context on the rehospitalization rates of infants born preterm. J Pediatr. 2017;190. https://doi.org/10.1016/j.jpeds.2017.08.001.

  20. Lagatta J, Murthy K, Zaniletti I, Bourque S, Engle W, Rose R et al. Home oxygen use and 1-year readmission among infants born preterm with bronchopulmonary dysplasia discharged from children’s hospital neonatal intensive care units. J Pediatr. 2020;220. https://doi.org/10.1016/j.jpeds.2020.01.018.

  21. Tessum CW, Paolella DA, Chambliss SE, Apte JS, Hill JD, Marshall JD. PM2.5 polluters disproportionately and systemically affect people of color in the United States. Sci Adv. 2021;7. https://doi.org/10.1126/sciadv.abf4491.

  22. White K, Borrell LN. Racial/ethnic residential segregation: framing the context of health risk and health disparities. Health Place. 2011;17. https://doi.org/10.1016/j.healthplace.2010.12.002.

  23. Morello-Frosch R, Lopez R. The riskscape and the color line: examining the role of segregation in environmental health disparities. Environ Res. 2006;102. https://doi.org/10.1016/j.envres.2006.05.007.

  24. Mahajan S, Caraballo C, Lu Y, Valero-Elizondo J, Massey D, Annapureddy AR et al. Trends in differences in health status and health care access and affordability by race and ethnicity in the United States, 1999–2018. JAMA. 2021;326. https://doi.org/10.1001/jama.2021.9907.

  25. Bouchelle Z, Vasan A, Candon M, Kenyon CC. Food insufficiency following discontinuation of monthly child tax credit payments among lower-income US households. JAMA Health Forum. 2022;3:e224039.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tessum CW, Apte JS, Goodkind AL, Muller NZ, Mullins KA, Paolella DA et al. Inequity in consumption of goods and services adds to racial-ethnic disparities in air pollution exposure. Proc Natl Acad Sci USA. 2019;116. https://doi.org/10.1073/pnas.1818859116.

  27. Morris BH, Gard CC, Kennedy K, Vohr B, Wilson-Costello D, Steichen J et al. Rehospitalization of extremely low birth weight (ELBW) infants: are there racial/ethnic disparities? J Perinatol. 2005;25. https://doi.org/10.1038/sj.jp.7211361.

  28. Massey DS, Condran GA, Denton NA. The effect of residential segregation on black social and economic well-being. Social Forces. 1987;66. https://doi.org/10.1093/sf/66.1.29.

  29. Mari KE, Yang N, Boland MR, Meeker JR, Ledyard R, Howell EA, et al. Assessing racial residential segregation as a risk factor for severe maternal morbidity. Ann Epidemiol. 2023. https://doi.org/10.1016/j.annepidem.2023.04.018

    Article  PubMed  Google Scholar 

  30. Zhang H, Nilan K, Dysart K, Fox W, Jensen E, Maschhoff K et al. Caring for infants with severe chronic lung disease (cld)—five year experience of a multidisciplinary care program. 2018. https://doi.org/10.1542/peds.141.1_meetingabstract.506.

  31. Chaiyachati BH, Peña MM, Montoya-Williams D. The complicated inadequacy of race and ethnicity data. JAMA Pediatr. 2022;176. https://doi.org/10.1001/jamapediatrics.2022.0525.

  32. Wickham H, Navarro D, Pedersen TL. ggplot2: Elegant Graphics for Data Analysis (No. 978-3-319- 24277–4; Second). Springer. 2016 https://doi.org/10.1007/978-0-387-98141-3.

Download references

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Timothy D. Nelin, Nancy Yang, Joshua Radack, Scott A. Lorch, Sara B. DeMauro, Nicolas A. Bamat, Erik A. Jensen, Kathleen Gibbs & Heather H. Burris

  2. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Timothy D. Nelin, Scott A. Lorch, Sara B. DeMauro, Nicolas A. Bamat, Erik A. Jensen, Kathleen Gibbs & Heather H. Burris

  3. Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Timothy D. Nelin & Heather H. Burris

  4. Leonard Davis Institute of Health Economics, Philadelphia, PA, USA

    Scott A. Lorch & Heather H. Burris

  5. Neonatal Follow-Up Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Sara B. DeMauro

  6. Newborn/Infant Chronic Lung Disease Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Nicolas A. Bamat, Erik A. Jensen & Kathleen Gibbs

  7. Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Allan C. Just

Authors
  1. Timothy D. Nelin
    View author publications

    Search author on:PubMed Google Scholar

  2. Nancy Yang
    View author publications

    Search author on:PubMed Google Scholar

  3. Joshua Radack
    View author publications

    Search author on:PubMed Google Scholar

  4. Scott A. Lorch
    View author publications

    Search author on:PubMed Google Scholar

  5. Sara B. DeMauro
    View author publications

    Search author on:PubMed Google Scholar

  6. Nicolas A. Bamat
    View author publications

    Search author on:PubMed Google Scholar

  7. Erik A. Jensen
    View author publications

    Search author on:PubMed Google Scholar

  8. Kathleen Gibbs
    View author publications

    Search author on:PubMed Google Scholar

  9. Allan C. Just
    View author publications

    Search author on:PubMed Google Scholar

  10. Heather H. Burris
    View author publications

    Search author on:PubMed Google Scholar

Contributions

TDN and HHB conceptualized and designed the study, collected data, coordinated and supervised data collection, carried out analysis, interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. ACJ conceptualized and designed the study, collected data, coordinated and supervised data collection, carried out analysis, interpreted the data, and critically reviewed and revised the manuscript. NY and JR carried out the analysis. SAL, SBD, NAB, EAJ, and KG conceptualized the study, critically reviewed and revised the manuscript.

Corresponding author

Correspondence to Timothy D. Nelin.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nelin, T.D., Yang, N., Radack, J. et al. Associations of neighborhood social vulnerability with emergency department visits and readmissions among infants with bronchopulmonary dysplasia. J Perinatol 43, 1308–1313 (2023). https://doi.org/10.1038/s41372-023-01735-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-023-01735-z

This article is cited by

Search

Advanced search

Quick links