Social determinants of necrotizing enterocolitis-associated mortality in very low birth weight infants: a population based study

Objectives Necrotizing enterocolitis (NEC) remains a leading cause of morbidity and mortality among very low birth weight (VLBW) infants. This study examined associations between maternal social determinants of health (SDoH) and NEC-related infant mortality among VLBW infants. Methods This retrospective cross-sectional study used Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiological Research (CDC WONDER) linked birth and death records from 2017 to 2023. Associations between maternal SDoH and NEC-related mortality were assessed using logistic regression. Results Among 271,411 VLBW births, 1,725 NEC-associated deaths occurred, yielding a mortality rate of 6.36 per 1,000 live VLBW births. Younger maternal age, unmarried status, Medicaid insurance, and residence in the southern United States were associated with increased mortality risk. Infants of American Indian or Alaska Native (AIAN) mothers also had higher odds of NEC-related death, whereas infants of mothers aged 30–34 years or with a bachelor’s degree or higher had reduced risk. Conclusions Maternal socioeconomic disparities are associated with NEC-associated mortality in VLBW infants, underscoring the need to address these disparities to improve outcomes.