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  • Author
    Reem Karmouta
  • PI

    Dr. Alison Chu, M.D.

  • Co-Author

    Marie Altendahl B.A., Irena Tsui M.D., Monica Khitri M.D.

  • Title

    Social Determinants of Retinopathy of Prematurity

  • Program

    STTP

  • Other Program (if not listed above)

  • Abstract

    HYPOTHESIS

    Socioeconomic determinants of health, such as lower household income and public insurance, rather than race, are associated with worse retinopathy of prematurity (ROP) outcomes and severity.

    STUDY DESIGN

    A retrospective chart review was performed for 745 neonates screened for ROP in the neonatal intensive care unit (NICU) at UCLA Mattel Children's Hospital (152), UCLA Santa Monica (70), Cedars-Sinai (298), and Harbor-UCLA (99) between January 1, 2015 and December 31, 2020. Demographic information (sex, race, ethnicity, primary language, ZIP code, health insurance status), medical history, NICU admission data, NICU outcomes, and ROP exam data were collected. ROP classification was performed using participants' worst ROP exam. ROP classifications included: no ROP, low-grade ROP, and type 1 ROP (most severe). ANOVA adjusted via the Bonferroni method and Chi-squared analyses were used to determine differences in gestational age, median household income, and health insurance by race/ethnicity. Independent logistic regression models were used to test associations between gestational age and ROP severity, household income and ROP severity, health insurance and ROP severity, and race/ethnicity and ROP severity. Independent logistic regression models were also used to test associations between gestational age and ROP treatment, household income and ROP treatment, health insurance and ROP treatment, and race/ethnicity and ROP treatment. A multivariate regression model was used to then determine the relationship between gestational age, household income, health insurance, race/ethnicity, and need for ROP treatment. The same multivariate regression model was used to determine the relationship between gestational age, household income, health insurance, race/ethnicity, and ROP severity. 

    RESULTS

    In univariate analyses, Hispanic ethnicity was associated with greater ROP severity (p=0.001). Additionally, neonates with lower gestational age (p<0.0001) and public health insurance (p=0.0005) were more likely to have low-grade ROP. Neonates with lower gestational age (p<0.0001), lower median household income (p=0.0012), and public health insurance (p=0.0005) were more likely to have type 1 ROP. Similarly, Hispanic ethnicity was associated with greater need for ROP treatment (p=0.003). Neonates with lower gestational age (p<0.0001), lower median household income (p=0.0001), and public health insurance (p=0.003) were more likely to be treated for ROP. In multivariate analyses, when co-varying for socioeconomic factors and gestational age, Hispanic ethnicity was no longer associated with increased ROP severity and need for ROP treatment. Gestational age was the only variable that was significantly associated with greater ROP severity and need for treatment in multivariate analyses (p<0.0001). 

    CONCLUSION

    Our study demonstrated that lower gestational age, public health insurance, and lower median household income are associated with more severe ROP and/or ROP needing treatment. Additionally, in our univariate analyses, Hispanic ethnicity was associated with more severe ROP and ROP needing treatment. However, once we adjusted for key socioeconomic factors, Hispanic ethnicity was not significantly associated with greater ROP severity and need for treatment. While previous studies have suggested race and ethnicity as ROP risk factors, our findings underline that it is vital to consider race and ethnicity in the context of socioeconomic determinants of health when assessing for ROP risk. Furthermore, our study emphasizes the importance of understanding race as a social construct rather than a biological one. Thus, addressing socioecnomic disparities may significantly reduce ROP burden.

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    https://uclahs.zoom.us/j/99509140186?pwd=UXFQVzAzVmdUeEpFOXZFUmtJVURSdz09