P3.154: Differences in Healthcare Resource Utilization by Race/Ethnicity among Moderate to Late Preterm Infants with Respiratory Distress Syndrome, Northern California

Background: The United States has one of the highest preterm birth rates among developed countries, with disproportionately higher rates among Black and Hispanic mothers. RDS, a common complication of preterm birth, is more prevalent in these groups and contributes to higher morbidity. While racial/ethnic disparities in healthcare resource utilization (HCRU) among extremely preterm infants are well-established, less is known about more mature preterm infants. To address this gap, this study evaluated racial/ethnic disparities in HCRU among moderate to late preterm infants with RDS.

Methods: We conducted a retrospective cohort study using electronic health record data from Kaiser Permanente Northern California (2019–2023). The study included liveborn moderate (32–33 6/7 weeks) and late (34–36 6/7 weeks) preterm infants with RDS (ICD-10-CM P22.0) requiring >12 hours of respiratory support during birth hospitalization. HCRU was evaluated during birth hospitalization (respiratory support duration, hospital and NICU length of stay [LOS]) and up to one-year post-discharge (emergency department [ED] visits, hospitalizations). Race/ethnicity was determined from maternal self-reported data. Associations by race/ethnicity (Black, Hispanic, Asian vs. white) were estimated using generalized linear and logistic regression to determine adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: Among 1,674 moderate to late preterm infants with RDS, 37.5% were white, 22.4% Hispanic, 17.4% Asian, and 7.4% Black. While infant sex, gestational age, and Apgar scores were similar across race/ethnicity, Black and Hispanic infants were more likely to be born via Cesarean, have lower birth weights, and reside in areas with higher neighborhood deprivation (Table 1). No significant racial/ethnic differences were observed among short-term outcomes (respiratory support, LOS) during hospitalization (Table 1). However, disparities emerged post-discharge. Black and Hispanic infants had significantly higher odds of ED visits within one year post-discharge compared to white infants (Black: aOR=1.79, 95% CI: 1.19–2.68; Hispanic: aOR=1.59, 95% CI: 1.20–2.10). These associations were even stronger for respiratory-related ED visits among Black (aOR=2.18, 95% CI: 1.22–3.91) and Hispanic infants (aOR=2.07, 95% CI: 1.34–3.19). Hispanic infants also had higher odds of respiratory/infectious respiratory-related hospitalizations (aOR=2.53, 95% CI: 1.11–5.78) (Figure 1).

Conclusion: Although short-term HCRU during birth hospitalization was similar across race/ethnicity, significant disparities emerged post-discharge. Black and Hispanic infants experienced significantly higher odds of ED visits, particularly for respiratory-related conditions, and Hispanic infants also had increased odds of respiratory-related hospitalizations. These findings highlight the need to better understand factors influencing long-term outcomes and the potential impact of structural inequities on post-discharge outcomes. These findings also emphasize the importance of targeted efforts to improve access to follow-up care, particularly to prevent respiratory-related morbidity in this population.