491 - Neighborhood deprivation and association with 18-month neurodevelopmental outcomes of preterm infants born in a dense urban setting

Poster Number: 491
Publication Number: 491.1483

Background: Area deprivation index (ADI), a composite measure of 17 Census variables designed to describe socioeconomic disadvantage within a given neighborhood based on income, education, and household characteristics, is an independent risk factor for morbidity and mortality in preterm infants. However, neighborhood adversity’s impact on 18-month neurodevelopmental outcomes (NDO) of infants born preterm is not well described.

Objective: To determine whether ADI at birth is associated with 18-month corrected age (CA) NDO of preterm infants born between 23-32 week gestational age (GA) in a dense urban setting.

Design/Methods: A retrospective case-cohort study was performed in inborn infants born at 23-32 weeks GA with birth weight (BW) ≤1250g and admitted to a level IV neonatal intensive care unit at Columbia University Medical Center between 2013-17 and then seen in follow up clinic through December 2020, to evaluate for NDO at 18-months CA. Socioeconomic deprivation was computed geospatially using subject addresses to generate a 12-digit Federal Information Processing Standards score code that was mapped to national ADI percentile (1-100) ranking. Based on the ADI distribution at birth, subjects were categorized as from low ( < 26 percentile) or high (26-100 percentile) ADI neighborhoods. Neurodevelopmental outcomes were assessed using the Bayley-3 cognition, language or motor composite scores at 18-months CA. The relationship between ADI and NDO was analyzed using logistic regression adjusting for GA and BW. Further, NDO outcomes from low and high ADI groups were compared using t-test.

Results: ADI and NDO data were available in 119 infants (mean GA=27.2±2.2 weeks, mean BW=870±246 g). The distribution of ADI percentiles from the National Area Depreciation Index Atlas was skewed to the left with the majority of the infants born from low ADI percentiles neighborhoods, as shown in Figure 1. Cognition, language and motor composite scores on the Bayley-3 at 18-months CA decreased with increasing ADI percentiles, as shown in Figure 2. Infants from lower ADI neighborhoods at birth had higher cognition, language and motor composite scores at 18-months CA (Table 1).

Conclusion(s): Among preterm infants born between 23-32 weeks GA in a dense urban setting, ADI at birth was associated with NDO at 18-months CA with infants from lower ADI neighborhoods exhibiting higher cognitive, language and motor scores on the Bayley-3. These findings suggest that neighborhood factors influence neurodevelopment and should be considered in developing public health measures to improve NDO for preterm infants from disadvantaged areas.