7UCSF Benioff Children's Hospital, San Francisco, CA8Alta Bates Summit Medical Center, Berkeley, CA9UCSF Benioff Children's Hospital Oakland, Oakland, CA10Children's Mercy Hospital, Kansas City, MO11Women and Children's Hospital of Buffalo, Buffalo, NY12Anne and Robert H. Lurie Children's Hospital/Northwestern University, Chicago, IL13Texas Children's Hospital, Houston, TX14Stony Brook University Hospital, Stony Brook, NY15University of Washington, Seattle, WA16University of Texas Health Science Center, Houston, TX17University of Florida College of Medicine, Jacksonville, UF Health Shands Hospital, Wolfson Children's Hospital, Jacksonville, FL18Wake Forest School of Medicine and Forsyth Medical Center, Winston Salem, NC19University of Minnesota Amplatz Children's Hospital, Minneapolis, MN20Medical University of South Carolina, Charleston, SC21Children's Hospitals and Clinics of Minnesota, St. Paul, MN22Children's Hospitals and Clinics of Minnesota, Minneapolis, MN23University of Tennessee Health Science Center, Memphis, TN24All Children's Hospital, St. Petersburg, FL25Florida Hospital for Children, Orlando, FL26Arkansas Children's Hospital, University of Arkansas Medical Sciences, Little Rock, AK27Clinical Coordinating Center28Department of Pediatrics, University of California San Francisco, San Francisco, CA29Data Coordinating Center30Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA1Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA2Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH3Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA5Department of Pediatrics, UCSF Benioff Children's Hospital, Oakland, CA6Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA
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ObjectiveTo evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship.Study designWe assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis.ResultsOf 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively.ConclusionsAmong former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences.Trial registrationClinicalTrials.gov: NCT01022580.