Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia
Tamorah Lewis, Matthew J. Kielt, Valencia P. Walker, Jonathan C. Levin, Milenka Cuevas Guamán, Howard B. Panitch, Leif D. Nelin, Steven H. Abman, Bronchopulmonary Dysplasia Collaborative, Richard Sindelar, William E. Truog, Joseph M. Collaco, Martin Keszler, Paul E. Moore, Bruce Schulman, Beena G. Sood, Lystra P. Hayden, A. Ioana Cristea, Khanh Lai, Lawrence Rhein, Sherry E. Courtney, David N. Cornfield, Robert DiGeronimo, Manvi Bansal, Susan J Gage, Rajeev Bhatia, Roopa Siddaiah, Antonia P Papova, Megan Lagoski, Joanne Lagatta
Abstract
Importance: Bronchopulmonary dysplasia (BPD) is the most common serious morbidity of preterm birth. Short-term respiratory outcomes for infants with the most severe forms of BPD are highly variable. The mechanisms that explain this variability remain unknown and may be mediated by racial disparities. Objective: To determine the association of maternal race with death and length of hospital stay in a multicenter cohort of infants with severe BPD. Design, Setting, and Participants: This multicenter cohort study included preterm infants enrolled in the BPD Collaborative registry from January 1, 2015, to July 19, 2021, involving 8 BPD Collaborative centers located in the US. Included patients were born at less than 32 weeks' gestation, had a diagnosis of severe BPD as defined by the 2001 National Institutes of Health Consensus Criteria, and were born to Black or White mothers. Exposures: Maternal race: Black vs White. Main Outcomes and Measures: Death and length of hospital stay. Results: Among 834 registry infants (median [IQR] gestational age, 25 [24-27] weeks; 492 male infants [59%]) meeting inclusion criteria, the majority were born to White mothers (558 [67%]). Death was observed infrequently in the study cohort (32 [4%]), but Black maternal race was associated with an increased odds of death (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) after adjusting for center. Black maternal race was also significantly associated with length of hospital stay (adjusted between-group difference, 10 days; 95% CI, 3-17 days). Conclusions and Relevance: In a multicenter severe BPD cohort, study results suggest that infants born to Black mothers had increased likelihood of death and increased length of hospital stay compared with infants born to White mothers. Prospective studies are needed to define the sociodemographic mechanisms underlying disparate health outcomes for Black infants with severe BPD.