Social Determinants of Health and Pediatric Brain Tumor Neuropsychological Morbidities

Neurocognitive and psychological morbidity risk is well-documented among pediatric brain tumor (PBT) survivors, yet most known predictors are nonmodifiable, limiting the implementation of a prevention approach. The social and environmental context has been increasingly considered, yet extant research primarily studies individual-level proxy measures (e.g., insurance). This cross-sectional study aimed to examine community-level factors that may contribute to neurocognitive and psychological outcomes in PBT survivors.

Participants were clinically referred PBT survivors who completed a neuropsychological evaluation (N = 160, M age = 11.28, SD = 4.69, 57.5% male, 75.0% White), including an age-appropriate Wechsler scale and parent-report questionnaires (Behavior Rating Inventory of Executive Function, Child Behavior Checklist). Nationally normed and locally normed Child Opportunity Index (COI) scores were assigned using census tract geocoding. Higher scores reflect more resources and higher opportunity.

Multivariate models including covariates found that National COI rank was associated with intellectual functioning (β = 0.37, 95% CI [0.24, 0.49]), and parent-reported executive functions (β = -0.20, 95% CI [-0.365, -0.06]), and psychosocial functioning (β = -0.18, 95% CI [-0.35, -0.05]). Local COI rank had similar effects (p < 0.01). Specific National and Local COI domains had differing effects across outcomes. Radiation treatment was significantly associated with parent-reported outcomes (p < 0.05) but not intellectual functioning.

Findings suggest community-level social determinants of health are associated with neurocognitive and psychological outcomes in PBT survivors. The COI may be useful to inform individual-level interventions and community-level policy to mitigate neuropsychological problems following PBT treatment in children from lower-opportunity communities. Exploration of specific educational, health, or social/economic indicators may highlight targets for a problem-prevention approach to reducing PBT survivors' risk for morbidities.