Department of Pediatrics, Division of Critical Care Medicine, School of Medicine, University of California, San Francisco, California, USA.
Department of Pediatrics, Division of Neonatology, School of Medicine, University of California, San Francisco, California, USA.
Pediatr Pulmonol. 2023 Apr;58(4):1237-1246. doi: 10.1002/ppul.26328. Epub 2023 Feb 8.
We sought to investigate how race, ethnicity, and socioeconomic status relate to tracheostomy insertion and post-tracheostomy mortality among infants with bronchopulmonary dysplasia (BPD).
The Vizient Clinical Database/Resource Manager was queried to identify infants born ≤32 weeks with BPD admitted to US hospitals from January 2012 to December 2020. Markers of socioeconomic status were linked to patient records from the Agency for Healthcare Research and Quality's Social Determinants of Health Database. Regression models were used to assess trends in annual tracheostomy insertion rate and odds of tracheostomy insertion and post-tracheostomy mortality, adjusting for sociodemographic and clinical factors.
There were 40,021 ex-premature infants included in the study, 1614 (4.0%) of whom received a tracheostomy. Tracheostomy insertion increased from 2012 to 2017 (3.1%-4.1%), but decreased from 2018 to 2020 (3.3%-1.6%). Non-Hispanic Black infants demonstrated a 25% higher odds (aOR 1.25, 1.09-1.43) and Hispanic infants demonstrated a 20% lower odds (aOR 0.80, 0.65-0.96) of tracheostomy insertion compared with non-Hispanic White infants. Patients receiving public insurance had increased odds of tracheostomy insertion (aOR 1.15, 1.03-1.30), but there was no relation between other metrics of socioeconomic status and tracheostomy insertion within our cohort. In-hospital mortality among the tracheostomy-dependent was 14.1% and was not associated with sociodemographic factors.
Disparities in tracheostomy insertion are not accounted for by differences in socioeconomic status or the presence of additional neonatal morbidities. Post-tracheostomy mortality does not demonstrate the same relationships. Further investigation is needed to explore the source and potential mitigators of the identified disparities.
本研究旨在探讨种族、民族和社会经济地位与支气管肺发育不良（BPD）婴儿气管切开术插入和气管切开术后死亡率的关系。
通过查询 Vizient 临床数据库/资源管理器，确定 2012 年 1 月至 2020 年 12 月期间在美国医院住院的胎龄≤32 周患有 BPD 的婴儿。社会决定健康因素数据库的医疗保健研究和质量局将社会经济地位的标志物与患者记录相关联。使用回归模型评估每年气管切开术插入率以及气管切开术插入和气管切开术后死亡率的趋势，同时调整社会人口统计学和临床因素。
本研究共纳入 40021 例早产儿，其中 1614 例（4.0%）接受了气管切开术。气管切开术的插入率从 2012 年到 2017 年有所增加（3.1%-4.1%），但从 2018 年到 2020 年有所下降（3.3%-1.6%）。与非西班牙裔白人婴儿相比，非西班牙裔黑人婴儿的气管切开术插入几率高 25%（优势比 1.25，1.09-1.43），而西班牙裔婴儿的几率低 20%（优势比 0.80，0.65-0.96）。接受公共保险的患者气管切开术的几率增加（优势比 1.15，1.03-1.30），但在我们的队列中，社会经济地位的其他指标与气管切开术的插入之间没有关系。气管切开术依赖者的院内死亡率为 14.1%，与社会人口统计学因素无关。
气管切开术插入的差异不能用社会经济地位的差异或新生儿其他合并症的存在来解释。气管切开术后的死亡率与这些因素没有关系。需要进一步调查以探讨所确定的差异的来源和潜在缓解因素。
