Racial and ethnic disparities in immunization rates among infants with bronchopulmonary dysplasia: a retrospective cohort study

Bronchopulmonary dysplasia (BPD) is the second most common chronic lung disease of childhood. Children with BPD experience higher health care utilization than children without BPD and are particularly vulnerable to severe respiratory infections, including respiratory syncytial virus (RSV). These risks may be exacerbated by racial and ethnic disparities in immunization rates. To evaluate racial and ethnic differences in influenza and RSV immunization rates among patients with BPD and the association with adverse health outcomes. Mixed-effects multinomial logistic and logistic regression models were used to evaluate the associations between immunization status and (1) race/ethnicity and (2) adverse respiratory outcomes within the multicenter BPD Collaborative registry. Among 1,185 patients with BPD, we found that Non-Hispanic (NH) white patients had higher relative risk of being unimmunized versus fully immunized for influenza compared to NH Black patients (RRR: 1.10 (95% CI: 1.01, 1.20)). Partially immunized patients had higher odds of post-discharge rescue medication use compared to fully immunized patients for influenza (aOR: 2.02 (95% CI: 1.47, 2.76)) and RSV (aOR: 1.66 (95% CI: 1.16, 2.37)). Partially immunized patients had higher odds of systemic corticosteroid use for acute symptoms compared to fully immunized patients for influenza (aOR: 2.03 (95% CI: 1.43, 2.86)) and RSV (aOR: 1.68 (95% CI: 1.13, 2.51)). Racial and ethnic disparities in influenza immunization were observed among infants and young children with BPD, with NH white patients more likely to be unimmunized than NH Black patients. Partially immunized patients for both influenza and RSV had increased rescue medication use compared to fully immunized patients.