Impact of Social Determinants of Health on Follow-up for Neonates Requiring Neurocritical Care

Abstract

Objective

This study aimed exploration of associations of social determinants of health (SDH) with attrition rates of neurocritical care graduates at follow-up.

Study Design

An observational retrospective cohort study was conducted to evaluate the attrition rates of an infant's first appointment scheduled with the NeuroNICU follow-up clinic in correlation with SDH.

Results

The “No Show” group was more likely to have unemployed (p = 0.014), black or multiracial mothers (p = 0.005), public insurance (p < 0.001), lower gestational age (p < 0.001), live further from the clinic (0.011), and a lower zip code-associated income (p = 0.008). After controlling for driving time, race, and education, infants who had private insurance were 2.268 times more likely to attend their follow-up visit when compared with infants who had public insurance (p = 0.014).

Conclusion

A significant SDH-related difference existed among the “Show” and “No Show” groups. Identifying these factors during neonatal intensive care unit (NICU) admission can facilitate targeted support for families while inpatient and promote improved outpatient follow-up.

Key Points

• Follow-up for neonates requiring neurocritical care is strongly influenced by social determinants.

• Standardized SDH screening in NICUs, identifying high-risk infants for attrition, is used by few.

• Factors influencing disparities in the utilization of follow-up programs require further study.

• Equity-based attrition prevention interventions could improve outcomes and reduce costs.

Keywords

attrition - infant follow-up - social determinants of health

Ethical Approval

This was a research-expedited study approved by the Indiana University Institutional Review Board. The study was performed in accordance with the Declaration of Helsinki.

Publication History

Received: 30 July 2024

Accepted: 25 November 2024

Accepted Manuscript online:
26 November 2024

Article published online:
24 December 2024

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