Shared Sociodemographic Risk Factors for Neurocognitive Dysfunction in Children With Cancer and Blood Disorders

To investigate the role of social determinants of health (SDoH) in neurocognitive functioning among children with acute lymphoblastic leukemia (ALL), central nervous system (CNS) tumors, and sickle cell disease (SCD).

Fifty-eight child-caregiver dyads participated. SDoH included components of socioeconomic status (SES; family income, caregiver education, and insurance type), race/ethnicity, caregiver marital status, and neighborhood-level deprivation. Neurocognitive functioning was measured using the NIH Toolbox Cognition Battery (NIHTB-CB) Fluid Cognition subtests.

There were no differences in SDoH between the three diagnosis groups other than expected differences in race/ethnicity (χ² (4, n = 51) = 46.1, p < 0.001). Bivariate analyses found a significant association between family income and working memory (r = 0.31, p < 0.05), processing speed (r = 0.29, p < 0.05), and fluid cognition composite scores (r = 0.29, p < 0.05). No other SDoH were associated with neurocognitive functioning. Family income remained significantly associated with performance on working memory (β = 0.35, p < 0.05), processing speed (β = 0.33, p < 0.05), and fluid cognition composite scores (β = 0.29, p < 0.05) after controlling for diagnosis, age, and sex.

Lower family income emerged as an important element of SES associated with poorer neurocognitive functioning in children treated for cancer and blood disorders. Further research is needed to determine how family income alters neurocognitive functioning, whether by altering the timing of emergence or the magnitude of deficits. Future studies should investigate mechanisms linking low income to neurocognitive performance to inform interventions to bolster neurocognitive development.