Respiratory Outcomes in Infants and Children With Bronchopulmonary Dysplasia Living in Rural Areas

Rationale Bronchopulmonary dysplasia (BPD) is the most common respiratory complication of preterm birth, and various environmental exposures have been associated with long‐term outcomes. Rural patients face unique challenges with regard to their environmental exposures and distance to care. Objective To assess differences in acute and chronic respiratory outcomes between infants and children with BPD residing in rural areas, as defined by distance to tertiary care and population density, and those residing in urban and suburban areas. Methods A retrospective cohort study of 1116 subjects who were recruited from an outpatient BPD Clinic between January 2008 and January 2025 was performed. Data were collected through chart review and caregiver questionnaires obtained at routine clinic visits. Rurality was defined by both distance to Johns Hopkins Children's Center (JHCC) in miles as well as population density in persons per square mile (ppsm) of an individual's home zip code. Data were analyzed using chi‐square, t‐tests, and logistic regression. Results 22.5% of the study population lived in rural zip codes with < 500 ppsm. Rural patients were more likely to be white and have private health insurance. When comparing clinical outcomes, patients living in rural areas were less likely to be prescribed oral steroids compared to those living in suburban or urban settings. Conclusions Although there are demographic differences between those living in rural versus urban or suburban settings, outpatient respiratory outcomes are similar. Further work should explore specific environmental exposures and health care access issues that affect the rural population with BPD.