281 - Association between neighborhood-level housing characteristics and neurodevelopmental outcomes of infants discharged from the neonatal intensive care unit

Poster Number: 281
Publication Number: 281.2243

Background: Systemic inequality at the community level has deleterious effects on perinatal and childhood health and developmental outcomes. Unfavorable neighborhood housing characteristics have been associated with preterm birth and low birth weight. High overall neighborhood risk is associated with developmental delay in infants born prematurely. Furthermore, personal history of unstable housing is associated with increased childhood hospitalizations and lower scores on math and vocabulary assessments at school age. Infants discharged from the neonatal intensive care unit (NICU) are already at risk for neurodevelopmental impairment (NDI). Thus, we hypothesize that unfavorable housing characteristics at the block-group level will be associated with an increased risk of neurodevelopmental delay in this already vulnerable population.

Objective: To evaluate the association between block-group housing characteristics and NDI of infants discharged from the NICU.

Design/Methods: We used a retrospective cohort from a suburban Chicago hospital from 2005-2021 with available and complete Bayley Scales of Infant and Toddler Development (BSID) from the NICU follow up clinic. Demographic characteristics and billing addresses were abstracted. Addresses were geocoded and linked to four housing variables available from public sources, namely eviction filing rate, housing affordability, mortgage interest rate spread, and credit insecurity, which were standardized and summed to capture an overall composite housing measure based on qualitative work describing domains of structural racism (Table 1). Binary logistic regression was used to estimate associations.

Results: The sample included 245 patients with a BSID score available for all sub-scales. Of those, 124 (51%) had moderate or severe developmental delay, defined as a score less than 85 on any BSID sub-scale (Table 2). After adjustment for gestational age and block-group socioeconomic status, a one standard deviation increase in the composite housing score was associated with increased odds of any developmental delay (OR 1.22, p=.028) and increased odds of delay on the gross motor scale (OR 1.27, p=.012) (Table 3).

Conclusion(s): Our results indicate that living in a neighborhood with unfavorable housing characteristics is associated with increased risk of NDI in infants discharged from the NICU. This work supports the importance of community-level factors in disease distribution and development in this vulnerable population. These findings may be used to inform interventions at discharge as well as anti-discrimination advocacy and policy efforts.