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Racial disparities in health-related quality of life in a cohort of very-low-birth-weight 2- and 3-year-olds with and without asthma
  1. Beth Marie McManus,
  2. Stephanie Robert,
  3. Aggie Albanese,
  4. Mona Sadek-Badawi,
  5. Mari Palta
  1. University of Wisconsin-Madison, Madison, Wisconsin, USA
  1. Correspondence to Dr Beth Marie McManus, Population Health Sciences, University of Wisconsin-Madison, 707 WARF, 610 Walnut Street, Madison, WI 53726, USA; mcmanus2{at}


Background Children born very low birth weight (VLBW) are at risk for low health-related quality of life (HRQoL), compared with normal-birth-weight peers, and racial disparities may compound the difference. Asthma is the most pervasive health problem among VLBW children and is also more common among black than white children, partly due to unfavourable environmental exposures. This study explores racial disparities in HRQoL among VLBW children and examines whether potential disparities can be explained by asthma and neighbourhood disadvantage.

Methods The study population was the Newborn Lung Project, a cohort of infants (n=660) born VLBW in 2003–2004 in Wisconsin, USA, who were followed up at age 2–3. Multilevel linear regression models were used to examine the contributions of asthma, neighbourhood disadvantage, and other child and family socio-demographic covariates, to racial disparities in HRQoL at age 2–3. A child's HRQoL was measured using the Paediatric Quality of Life Inventory 4.0.

Results VLBW, black, non-Hispanic children, on average, score nearly 4 points lower (p<0.01) on HRQoL than do white, non-Hispanic children. Including asthma reduces the difference between black and white children from −3.6 (p<0.01) to 0.08 (p>0.05). The authors found no evidence that the relationship between asthma and HRQoL differs by race. The interaction between neighbourhood disadvantage and asthma is statistically significant, with further examination suggesting that racial disparities are particularly pronounced in the most advantaged neighbourhoods.

Conclusion The authors found that the black disadvantage in HRQoL among 2–3-year-old VLBW children likely stems from a high prevalence of asthma. Neighbourhood attributes did not further explain the disparity, as the racial difference was particularly pronounced in advantaged neighbourhoods.

  • Very low birth weight
  • health-related quality of life
  • neighbourhood disadvantage
  • asthma
  • multilevel models
  • premature infants

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  • Funding BMM acknowledges the Robert Wood Johnson Health and Society Scholar Program for funding this research. This research was also funded by the National Heart, Blood, and Lung Institute (HL038149).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of Wisconsin-Madison.

  • Provenance and peer review Not commissioned; not externally peer reviewed.