Racial disparities in health-related quality of life in a cohort of very-low-birth-weight 2- and 3-year-olds with and without asthma

Abstract

Background: Children born very low birth weight (VLBW) are at risk for low health-related quality of life (HRQoL), compared with normal-birth-weight peers, and racial disparities may compound the difference. Asthma is the most pervasive health problem among VLBW children and is also more common among black than white children, partly due to unfavourable environmental exposures. This study explores racial disparities in HRQoL among VLBW children and examines whether potential disparities can be explained by asthma and neighbourhood disadvantage.

Methods: The study population was the Newborn Lung Project, a cohort of infants (n=660) born VLBW in 2003-2004 in Wisconsin, USA, who were followed up at age 2-3. Multilevel linear regression models were used to examine the contributions of asthma, neighbourhood disadvantage, and other child and family socio-demographic covariates, to racial disparities in HRQoL at age 2-3. A child's HRQoL was measured using the Paediatric Quality of Life Inventory 4.0.

Results: VLBW, black, non-Hispanic children, on average, score nearly 4 points lower (p<0.01) on HRQoL than do white, non-Hispanic children. Including asthma reduces the difference between black and white children from -3.6 (p<0.01) to 0.08 (p>0.05). The authors found no evidence that the relationship between asthma and HRQoL differs by race. The interaction between neighbourhood disadvantage and asthma is statistically significant, with further examination suggesting that racial disparities are particularly pronounced in the most advantaged neighbourhoods.

Conclusion: The authors found that the black disadvantage in HRQoL among 2-3-year-old VLBW children likely stems from a high prevalence of asthma. Neighbourhood attributes did not further explain the disparity, as the racial difference was particularly pronounced in advantaged neighbourhoods.

Figures

Figure 1

Health-related quality of life, by neighborhood disadvantage, for white and black children with and without asthma, conditional on child and family characteristics* * conditional on birth weight, gestational age and neonatal severity at mean values, living in single parent household, and being exposed to prenatal smoking, living with a smoker, no prenatal care, and child attends daycare. **Neighborhood disadvantage was derived from principal component analysis of 5 socioeconomic indicators measured at the Census tract level. For interpretation, index scores were categorized as advantaged (>1 SD from mean), disadvantaged (> −1 SD below the mean), and otherwise, middle disadvantage.