Social determinants of health (SDOH) are social conditions (e.g., employment, access to healthcare, quality schools) which are shown by a growing body of literature to impact many health outcomes, including cognition. The development of community-level measures including the Child Opportunity Index (COI) have allowed for increased understanding of the resources and conditions in neighborhoods and their impact on children’s health. Given the limited existing research on how neighborhood factors impact cognitive development, this study aimed to examine associations between neighborhood context (COI) and cognitive outcomes in children and adolescents who presented for neuropsychological evaluations.

Participants included 4,633 youth (ages 2-22; M = 10.8 years; SD = 4.1 years; 63% Male; 33% with a medical condition involving the central nervous system [CNS]) living in the DC-VA-MD-WV Metro Area who presented to an outpatient clinic for evaluation and completed an intellectual functioning (IQ) measure (88% Weschler, 11% DAS, <1% Leiter, <1% RIAS). COI values were extracted from electronic medical records based on home address. COI values include an overall index and three domain scores in educational (educational access, quality, and outcomes), health/environment (access to healthy food, healthcare, and greenspace) and social/economic (income, employment, poverty); higher scores indicate higher opportunity. Using metro-based norms, children from all opportunity levels were represented (14% Very Low, 13% Low, 18% Moderate, 21% High, 34% Very High). Multiple regression analyses were conducted to examine main effect associations between COI and Full-Scale IQ (FSIQ), Verbal IQ (VIQ), and Non-Verbal IQ (NVIQ) and explore moderation of age, gender, and medical condition on these associations. Additional regression analyses examined these relationships for the three COI domains.

Controlling for age, gender, and medical condition, neighborhood opportunity was positively associated with cognitive function (FSIQ: ß=0.198; VIQ: ß=0.202; NVIQ: ß=0.148, p’s <0.01). Models accounted for approximately 10-14% percent of the variance in cognitive outcomes (FSIQ: F[6,4476]=180.331), Adj.R2=0.138; VIQ: F[6,4556]=161.931), Adj.R2=0.124; NVIQ: F[6,4548]=123.893), Adj.R2=0.098). Age moderated the association between overall COI and cognitive outcomes (FSIQ: ß=0.005, p=0.018; VIQ: ß=0.005, p=0.043; NVIQ: ß=0.005, p<0.01) such that the association between neighborhood opportunity and cognitive outcomes was stronger at older ages, though this was a small effect. When examining subdomains of COI, cognitive outcomes were associated with educational (FSIQ: ß=0.094; VIQ: ß=0.099; NVIQ: ß=0.078, p’s <0.01) and social/economic opportunity (FSIQ: ß=0.115; VIQ: B=0.121; NVIQ: ß=0.084, p’s <0.01) but not health/environmental opportunity (FSIQ: ß=-0.001, p=0.991; VIQ: ß=-0.008, p=0.581; NVIQ: ß=-0.008, p=0.553). Medical diagnosis moderated the association between social/economic opportunity and FSIQ; there was a stronger association between IQ and COI in youth with a medical diagnosis (ß=-0.071, p<0.05).

These findings demonstrate the importance of neighborhood factors, especially education and social/economic opportunities, on cognitive development. Children living in higher opportunity neighborhoods showed higher cognitive functioning. Older age and CNS-involved medical conditions were associated with higher risk in the context of reduced neighborhood opportunities. These findings emphasize the need for advocacy and other efforts to improve community resources (e.g., access to early childhood education) to address inequities in cognitive development.