186 - Association of Neighborhood Deprivation with Short-Term Outcomes in Neonates with Hypoxic Ischemic Encephalopathy

Publication Number: 1175.186

Movicque King, University of Virginia School of Medicine, Louisa, VA, United States; Kristin Putman, University of Virginia School of Medicine, Charlottesville, VA, United States; Surbhi Mathur, University of Virginia School of Medicine, Charlottesville, VA, United States; Sai K. Gajula, University of Virginia School of Medicine, Charlottesvile, VA, United States; Mark R. Conaway, University of Virginia School of Medicine, Charlottesville, VA, United States; Santina Zanelli, University of Virginia, Charlottesville, VA, United States

Background: Despite advances in neonatal care, outcome disparities persist among critically ill infants. Infants from minority and lower socioeconomic backgrounds experience higher rates of morbidity and mortality, including severe brain injury. Social determinants of health, including neighborhood deprivation measured by Area Deprivation Index (ADI), contribute significantly to these inequities, particularly for preterm infants. However, limited research has examined how ADI relates to outcomes in near-term and term infants with hypoxic ischemic encephalopathy (HIE).

Objective: To examine the impact of race, ethnicity, and ADI on short-term outcomes in neonates with HIE.

Design/Methods: This single center, retrospective cohort study included infants admitted with HIE to the UVA NICU from 2018 to 2023. Maternal age, race/ethnicity, and national ADI percentile from home addresses were collected. Outcome measures included encephalopathy severity based on EEG, length-of-stay (LOS), mortality, and referral and attendance at Early Development Clinic (EDC) follow-up. Median ADI was compared across groups using t-tests or ANOVA, and between ADI quartiles using chi-square or Fisher's exact tests. Competing risk analysis accounting for death before discharge and multivariable logistic regression were used to assess associations between ADI and LOS or follow-up metrics.

Results: 205 infants were included in the analysis. Our cohort was 79% White, 11% Black, and 8% Hispanic. 67% of the infants were outborn. The median ADI score was 54.5 (range 4-96) (Table 1). There was no significant difference in median ADI based on race or ethnicity (Fig 1A). No differences were observed in ADI based on HIE severity (Fig 1B). Outborn infants had a higher median ADI (53 vs 46, p = 0.013). Higher ADI was associated with longer LOS. This remained significant after adjusting for HIE severity and outborn status. Greater distance to UVA and not ADI was associated with lower odds of attending the follow-up visit (OR 0.988, 95% CI 0.979 - 0.997, p = 0.001) (Table 2).

Conclusion(s): Infants from higher ADI neighborhoods had significantly longer LOS despite similar HIE severity across ADI distribution. After discharge, distance from the referral center, rather than ADI, predicted loss to follow-up, though outborn birth and greater distance from UVA was associated with higher ADI. These findings highlight a disproportionate burden on families from remote and resource limited areas and merits further exploration to identify the barriers to timely discharge and disparities in access to post-discharge support.

Table 1. Cohort Demographics.
Data are reported as n (%), mean sd, or median (1st, 3rd quartiles). National ADI percentile ranges from 0-100, with higher scores indicating more neighborhood socioeconomic disadvantage.

Figure 1. Impact of ADI in neonates with HIE.
Panel A - ADI Distribution by Race. There was no significant difference in median ADI based on race. Panel B - Median ADI by HIE Severity. HIE severity was classified based on EEG interpretation by pediatric neurologist.

Table 2. A. Covariates and ADI Distribution/B. Regression analyses of relationship between ADI and LOS and follow up attendance
Table A demonstrates significantly different ADI distribution only for inborn vs outborn status and no significant difference in ADI based on mortality, race, ethnicity, sex, or HIE severity. Table B. Panel 1 examines the relationship between ADI and LOS using a competing risks analysis to account for inpatient deaths, demonstrating that higher ADI is associated with longer length of stay. Higher HIE severity is also associated with a longer LOS while being outborn is not associated with longer LOS. Panel 2 demonstrates a confirmatory analysis using in-patient death as a covariate and similarly demonstrates higher ADI is associated with longer LOS. Panel 3 examines the relationship between ADI and follow up attendance where there was no association between ADI and but significant association with distance from hospital with follow up. Note: p <0.05*, p <0.01**, p<0.001***