Impact of social determinants of health on outcomes in pediatric short bowel syndrome

Objective: To determine the impact of social determinants of health (SDOH) on outcomes in pediatric short bowel syndrome (SBS) patients. Methods: A retrospective cohort of SBS children managed by an Intestinal Rehabilitation Program was analyzed. Socio-economic variables including income, race, distance to hospital, parental education and immigrant status were chosen to assess whether they independently predicted the following outcomes: enteral autonomy (EA), central line associated blood stream infection (CLABSI), intestinal failure associated liver disease (IFALD), and mortality. Bowel anatomy, prematurity, and disease type were controlled for. Univariate analysis and Cox proportional hazards model (CPH) were performed, where an alpha-value of <0.05 was significant. Results: A total of 161 patients were analyzed between 2006 and 2019. The median gestational age was 34 (29.0-37.0) weeks and 61.9% were male. EA was achieved in 63.5%, 22.5% developed IFALD, and 10% died. The median CLABSI rate was 4.0 (0.4-11.1) per 1000 catheter days. CPH modeling revealed that the only social factor positively associated with attaining EA was non-white race (p = 0.03). Parental post-secondary education was associated with a lower risk of CLABSI (p = 0.04) while those living larger distances from hospital had an increased risk (p = 0.02). The development of IFALD was also positively associated with greater distance from hospital (p < 0.01). Mortality was positively associated with both having