Assessing Cognitive Functioning in Children With Brain Tumors: Interaction of Neighborhood Social Determinants of Health and Neurological Risk.
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BACKGROUND: This study investigated how neighborhood-level social determinants of health (SDOH), including redlining and neurological risk, interact to influence cognitive outcomes in children treated for brain tumors (CTBT). METHODS: A retrospective chart review of 161 CTBT aged 5-17 was conducted. Cognitive outcomes were measured using standardized neuropsychological assessments, and SDOH were assessed using the Childhood Opportunity Index (COI) and redlining data. The Neurological Predictor Scale (NPS) measured treatment-related neurological risk. RESULTS: Compared to moderate and high-opportunity neighborhoods, children in low-opportunity neighborhoods exhibited lower intellectual functioning (IF) (F[2, 154] = 17.7, p < 0.01, η2 = 0.19), processing speed (F[2, 89] = 4.41, p = 0.015, η2 = 0.09), perceptual reasoning (F[2, 64] = 3.60, p = 0.03, η2 = 0.10), and verbal reasoning (F[2, 90] = 10.09, p < 0.01, η2 = 0.18) scores. COI moderated the association between NPS and IF(F[2, 147] = 4.47, p = 0.013), with a negative effect of NPS on IF in high-opportunity neighborhoods (t = -3.82, p < 0.01). Children from neighborhoods less affected by redlining demonstrated better IF performance, U = 94.50, Z = -2.30, p = 0.021. CONCLUSIONS: The findings highlight the importance of considering both treatment-related neurological burden and neighborhood-level SDOH when evaluating cognitive outcomes in CTBT. Survivors from lower opportunity environments demonstrated the highest rates of cognitive impairment, whereas the interaction between neurological risk and outcomes was significant only among youth from high-opportunity neighborhoods. These results support a risk-informed approach to survivorship care that considers both contextual and medical factors.