Initial Survival and Short-term Pulmonary Comorbidities in Infants With Congenital Diaphragmatic Hernia of Differing Indices of Social Determinants of Health.

PURPOSE: To assess the association between social determinants of health (SDoH) and both mortality and pulmonary outcomes in infants with congenital diaphragmatic hernia (CDH).

METHODS

We conducted a retrospective observational cohort study of all patients with CDH at our institution from January 2004 to July 2023. Child opportunity index (COI) and area deprivation index (ADI) were determined from reported addresses at birth. Baseline demographics and details from initial hospitalization were described by COI quintiles. Outcomes of mortality and CDH-associated pulmonary outcomes were compared between COI quintiles.

RESULTS

Among the 281 patients, there were unequal distributions of race (p < 0.001) and ethnicity (p = 0.006) among the COI quintiles, with Black patients comprising a quarter of the very low COI quintile. In-hospital mortality, supplemental oxygen at discharge, reactive airway disease (RAD)/asthma, and differed significantly among the COI quintiles (p = 0.02, p = 0.024, p = 0.04). Multivariable regression analyses of composite outcomes (mortality or pulmonary comorbidities) demonstrated those in the very high vs. very low COI quintile had 20-31 % lower odds of requiring oxygen (O2) support and having pulmonary hypertension (PH) at discharge (p = 0.006, p = 0.029) and at 6 months (p = 0.01, p = 0.003), respectively. ADI similarly correlated with need for O2 support and PH in CDH infants at 6 months, AOR 1.03 (95 % CI 1.01-1.04), p = 0.001 and 1.02 (95 % CI 1-1.03), p = 0.029, respectively.

CONCLUSION

Children of very low COI and higher ADI with CDH may be at increased risk of mortality or pulmonary morbidities. Further studies are needed to better characterize this vulnerable population and to improve these SDoH-related disparities in CDH outcomes.