Neighborhood Opportunity and Cognitive Functioning in Pediatric Epilepsy
Abstract number :
1.364
Submission category :
11. Behavior/Neuropsychology/Language / 11B. Pediatrics
Year :
2022
Submission ID :
2205115
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Hayley Loblein, PhD – Children's National Hospital; Colleen Morris, BS – George Washington University School of Medicine; Leigh Sepeta, PhD – Children's National Hospital; Archana Pasupuleti, MD – Children's National Hospital; Rachael Tillman, PhD – Children's National Hospital; Madison Berl, PhD – Children's National Hospital
This abstract has been invited to present during the Pediatric Epilepsy Highlights platform session
Rationale: Social determinants of health (SDOH) are social conditions, such as healthcare access, food security, and economic stability, that can affect health, emotional/behavioral functioning, and quality of life. Despite evidence of the importance of neighborhood environment for children’s health, no study to date has examined associations between the Child Opportunity Index (COI), a multidimensional measure of neighborhood context, and cognitive outcomes in pediatric epilepsy. The aim of this retrospective cohort study was to examine whether neighborhood context (COI) is related to cognitive outcomes in children and adolescents with epilepsy.
Methods: A total of 83 patients with epilepsy between the ages of 6-16 who underwent neuropsychological evaluation were identified using an existing clinical registry. Patient addresses were geocoded to census tract geography and linked to the COI. The primary outcome was Full-Scale IQ (FSIQ) from the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V). Additional follow-up analyses examined subdomains of the COI (education, health & environment, social & economic) and indices of the WISC-V (Processing Speed, Working Memory, Verbal Comprehension, Fluid Reasoning, Visual Spatial). We hypothesized that greater neighborhood opportunity would be associated with higher cognitive functioning.
Results: A majority of patients were from high (25.3%) and very high (41.0%) opportunity neighborhoods, using national opportunity rankings. Opportunity levels were more evenly distributed using metro-based norms for those in the DC metro area (25% very high; 19.4% high; 19.4% moderate; 23.6% low; 12.5% very low). Linear regression revealed that COI z-scores predicted FSIQ (R2 = .159, F(3,82) = 15.31, p < .001). In multiple linear regression using the subdomains of COI, the education subdomain was the strongest predictor of FSIQ (R2 = .171, β = .361, p = .021). COI predicted all WISC-V indices except processing speed. The education subdomain was the strongest predictor across most indices.
Conclusions: These findings underscore the importance of neighborhood factors, particularly education, on cognitive development in pediatric epilepsy. Outcomes in pediatric epilepsy are not fully explained by medical variables alone, thus expanding our predictive models will increase our ability to counsel families. This research suggests that including social determinants of health will enhance our predictive models. Future work will examine whether individuals from low or high opportunity neighborhoods have different access to or respond differently to epilepsy intervention. This research also suggests that advocacy efforts to improve community resources, such as increased access to early childhood education, may help improve cognitive outcomes in children and adolescents with epilepsy.
Funding: This project was supported by Award Number UL1TR001876 from the NIH National Center for Advancing Translational Sciences.
Behavior