Addressing Health Inequities: Understanding the Relationship Between Social Determinants of Health and Necrotizing Enterocolitis

Introduction

Necrotizing enterocolitis (NEC) is a severe illness with high mortality. Traditional risk factors are prematurity and neonatal stress. Maternal risk factors have also been postulated but are often overlooked. We aimed to define parental and patient factors associated with NEC and their impact on outcomes.

Methods

Infants under 1 year old diagnosed with NEC were identified via the Pediatric Health Information System database between 2012 and 2022. The Childhood Opportunity Index (COI) was used to represent each family's household educational, environmental, and socioeconomic conditions. The COI was split into low, middle, and high levels and analyzed across demographics and mortality. Multivariable regression was used to determine the association between COI and in-hospital mortality, adjusting for gestational age, gender, race, primary payor, urban flag, and geographic region.

Results

Overall, 10,768 patients with a median gestational age of 29 weeks (IQR 25-34), and a median birthweight of 1,010 g (IQR 660-1,880 g) met inclusion criteria. The cohort was majority male (57 %), and White (46 %), and overall, had a mortality rate of 18 %. Low COI was associated with longer length of stay (56 vs. 53 days) and increased mortality (19 % vs. 15 %) when compared to high COI. On adjusted analysis, high COI was associated with decreased odds of death by time of discharge (OR 0.75, 95 % CI 0.65–0.86, p < 0.001) when compared to low COI.

Conclusion

NEC is a disease that disproportionately affects socially disadvantaged infants. The mortality rates of NEC are linked to parental social determinants of health, highlighting this unique population to target for risk assessment and additional prenatal resources.

Type of Study

Cross Sectional Study.

Level of Evidence

III.