Year of Publication
BACKGROUND: Bronchopulmonary dysplasia (BPD) is the most common long-term complication of prematurity. While socioeconomic status is associated with BPD morbidities, the drivers of this association are poorly understood. In the United States, ambient air pollution (AAP) exposure is linked to both race/ethnicity and socioeconomic status. Furthermore, AAP exposure is known to have a detrimental effect on respiratory health in children. As such, we set out to assess if AAP exposure is linked to BPD morbidity in the outpatient setting.
METHODS: Participants with BPD were recruited from outpatient clinics at Johns Hopkins University and the Children's Hospital of Philadelphia between 2008 and 2021 (n=800) and divided into low, moderate, and high AAP exposure groups, based on publicly available Environmental Protection Agency data. Clinical data were obtained by chart review and caregiver questionnaires.
RESULTS: Non-white race, home ventilator usage, and lower median household income were associated with higher levels of air pollution exposure. After adjustment for these factors, moderate and high air pollution exposure were associated with requiring systemic steroids (OR 1.78 and 2.17 respectively) compared to low air pollution. Similarly, high air pollution exposure was associated with emergency department visits (OR 1.59).
CONCLUSION: This study demonstrates an association between AAP exposure and BPD morbidity following initial hospital discharge. AAP exposure was closely linked to race and median household income. As such, it supports the notion that AAP exposure may be contributing to health disparities in BPD outcomes. Further studies directly measuring exposure and establishing a link between biomarkers of exposure and outcomes are prerequisites to developing targeted interventions protecting this vulnerable population.