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Early Impact of Childhood Opportunity on Neurocognitive Outcomes in Sickle Cell Disease

Julia E LaMotte1,2, Hannah Koch1, Olivia A Coughlin1,3

  • 1Indiana University School of Medicine, Indianapolis, Indiana, USA.

Pediatric Blood & Cancer
|July 29, 2026
PubMed

Insights

Social drivers of health, specifically neighborhood opportunity, significantly impact cognitive function in children with sickle cell disease (SCD). Higher childhood opportunity correlates with better neurocognitive and academic performance in these children.

Area of Science:

  • Pediatric Neurology
  • Social Determinants of Health
  • Sickle Cell Disease Research

Background:

  • Neurocognitive impairment is a common complication of sickle cell disease (SCD) affecting children.
  • Cerebrovascular injury is a known risk factor, but deficits also occur without overt stroke.
  • The influence of social drivers of health (SDoH) on SCD neurocognition is largely unexplored.

Purpose of the Study:

  • To investigate the association between neighborhood-level SDoH and neurocognitive outcomes in children with SCD.
  • To explore if SDoH modify neurocognitive performance independent of cerebrovascular injury.

Main Methods:

  • Retrospective cohort study of 90 children and adolescents with SCD.
  • Neurocognitive screening assessed visual-spatial, fluid reasoning, memory, language, processing speed, attention, and academics.
  • Neighborhood SDoH measured using the Childhood Opportunity Index (COI).

Main Results:

  • Most participants lived in areas with low childhood opportunity.
  • Higher COI scores were significantly linked to better performance in fluid reasoning, memory, language, reading, spelling, and math.
  • The COI education subdomain showed consistent associations with cognitive and academic measures.

Conclusions:

  • Neighborhood childhood opportunity is a strong predictor of neurocognitive outcomes in children with SCD, even without neurological injury.
  • Integrating SDoH into risk assessments is crucial for addressing cognitive disparities in SCD.
  • Early screening for SDoH in SCD care can identify structural factors affecting cognitive development.
Abstract

Keywords:
childhood opportunitypediatric hematology/oncologysickle cell diseasesocial drivers of health

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