title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Population Health Sciences, University of Wisconsin-Madison, 707 WARF, 610 Walnut Street, Madison, WI 53726, USA. mcmanus2@wisc.edu
authors.forename: Beth Marie
authors.initials: BM
authors.lastname: McManus
authors.forename: Stephanie
authors.initials: S
authors.lastname: Robert
authors.forename: Aggie
authors.initials: A
authors.lastname: Albanese
authors.forename: Mona
authors.initials: M
authors.lastname: Sadek-Badawi
authors.forename: Mari
authors.initials: M
authors.lastname: Palta
mesh_terms: D001741:Black or African American; D001249:Asthma; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016014:Linear Models; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014922:Wisconsin