291 - Social Determinants of Health Affecting Healthcare Cost in Near-Term Infants: Analysis from a National Cohort

Poster Number: 291
Publication Number: 291.2165

Background: The care of late preterm infants (LPIs), defined by 34 0/7 and 36 6/7 weeks of gestation, represents a substantial and increasing financial burden on the healthcare system in the United States. Although 35–36-weeks gestational age (GA) is classified as "near-term", they face distinct health challenges and often require prolonged hospitalization and associated cost. While there is a growing body of literature on the clinical factors affecting the care of near-term infants, less attention has been given to the social determinants of health (SDOH) that may contribute to the higher healthcare cost.

Objective: (1) To study cost differences in the care of term and LPIs (2) To investigate clinical and SDOH factors that predict higher costs in near-term infants.

Design/Methods: We accessed the national multicenter Kids' Inpatient Database (KID) Healthcare Cost and Utilization Project (HCUP) from the year 2019. We excluded encounters involving stillbirths, transfers out, and major congenital anomalies. LPIs were identified using ICD-10 codes (P0737-P0739). A logistic regression model was used to identify SDOH and clinical factors predicting higher costs (defined as exceeding the median cost of term infants for the cohort) in near-term infants. Weight-based analysis was performed using SAS 9.4 for a complex sample design.

Results: A total of 3,562,069 newborn birth admissions were analyzed; of these, 240,555 (6.75%) were LPIs. Total associated costs were 5.82B, 2.17B, and 6.01B for term, LPI, and other preterm infants, respectively. After exclusions, 217,100 infants were included in the final cohort (Table 1). Median (IQR) total and daily costs were significantly higher for near-term infants compared to term infants [35 weeks: Median-15,243 (6,442-51,053), Daily-3,651 (2,292-6,244); 36 weeks: Median-7,602 (4,735-17,919), Daily-2,892 (1,983-4,882) vs. Term: Median-4,604 (3,123-7,223), Daily-2,412 (1,739-3,547), p < 0.001]. Clinical factors predicting higher costs included birth weight < 2 kg, male gender, hyperbilirubinemia, feeding problems, hypoglycemia, and C-section deliveries. SDOH factors predicting higher costs were Medicaid insurance, higher socioeconomic status of parents, Hispanic and Native American race, and hospital location being urban teaching, west coast, and private sector hospitals (Figure 1).

Conclusion(s): To our knowledge, this is the largest cohort evaluating cost analysis in LPIs. It reveals a significant increase in the cost of caring for near-term infants compared to term infants. Intervention strategies targeting SDOH factors could help reduce the gap in healthcare costs.