Sociodemographic factors associated with tracheostomy and mortality in bronchopulmonary dysplasia

Abstract

Objectives: We sought to investigate how race, ethnicity, and socioeconomic status relate to tracheostomy insertion and post-tracheostomy mortality among infants with bronchopulmonary dysplasia (BPD). Methods: 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 posttracheostomy mortality, adjusting for sociodemographic and clinical factors. Results: 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. Conclusions: 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.

Trends in Natural Decannulation in Patients with Robin Sequence: A Twenty-five Year Retrospective Review

“…Racial influence on pediatric tracheostomy outcomes has previously been documented with black children undergoing higher rates of tracheostomy and higher comorbidity burden compared to white or Hispanic children. 42,43 However, there was no difference seen in rates of decannulation or mortality after tracheostomy. 42,43 The difference in decannulation rates between white children and other racial or ethnic groups in our cohort highlights potential health disparities and the impact of social determinants of health on comorbidity burden.…”

“…42,43 However, there was no difference seen in rates of decannulation or mortality after tracheostomy. 42,43 The difference in decannulation rates between white children and other racial or ethnic groups in our cohort highlights potential health disparities and the impact of social determinants of health on comorbidity burden. Further research is needed to assess for any differences in treatment efficacy among racial and ethnic groups including the associated socioeconomic influences and implicit biases.…”

Tracheostomy in Severe Bronchopulmonary Dysplasia—How to Decide in the Absence of Evidence

“…Some studies have reported the mortality rates from the time of tracheostomy to the time of initial hospital discharge with a range of 9–23% [ 11 , 12 ]. Other studies report a combined mortality rate from the time of tracheostomy placement to a specified amount of time in the outpatient setting, and the available evidence on mortality rates in patients that received a tracheostomy for BPD is described in Table 1 [ 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. In summary, the answer to the question “what are the chances that my child will survive into adulthood and beyond, like other children?” seems to be that there is a chance somewhere from 74% to 93% that a baby who receives a tracheostomy for BPD will survive their initial hospitalization and childhood.…”

To trach or not to trach? Ethical considerations for medically complex children during a home nursing crisis

“…In addition, those receiving public insurance had an increased rate of tracheostomy placement with longer length of hospital stay. Of note, there was no increased mortality among Black or Latinx patients or those with public insurance 10 . Those with the most limited access to care are, unfortunately, often those who need it most to ensure safety at home.…”

“…Of note, there was no increased mortality among Black or Latinx patients or those with public insurance. 10 Those with the most limited access to care are, unfortunately, often those who need it most to ensure safety at home. In a world of increasing healthcare disparities, we feel strongly that care for these patients should be consistent and equitable.…”