B-26: Associations Between Neighborhood Disadvantage and Adaptive Functioning Among Young Children With Congenital Heart Disease

Abstract

Objective: Young children with congenital heart disease (CHD) are at risk for neurodevelopmental impairments and deficits in adaptive functioning that impact quality of life. Social determinants of health, such as neighborhood disadvantage, contribute to adverse post-surgical outcomes, decreased healthcare access, and impaired neurodevelopmental outcomes among children with CHD. The impact of medical, demographic, and neighborhood risk factors on adaptive functioning in this population was explored. Method/Data Selection: Retrospective data from 104 children (aged 2-5) with CHD referred for cardiac neurodevelopmental evaluation (between 2020-2024) were analyzed. Area deprivation index (ADI) measured neighborhood-level socioeconomic disadvantage. A cumulative medical risk index, including prematurity, single ventricle history, neurologic abnormalities, genetic syndrome, and heart transplant was created. Hierarchical linear regressions examined medical risk, demographic context, ADI as predictors of adaptive outcomes in children with CHD. Results/Data Synthesis: Adaptive skills were mostly in the low average to below average ranges. Greater medical risk was associated with lower adaptive functioning (B=−3.93, 95% CI=-7.65- -.22, p=.04), while female sex was associated with higher adaptive functioning (B=7.77, 95% CI=.40-15.14, p=.04). However, ADI was not a significant predictor of adaptive functioning (B=−0.08, 95% CI=-.23-.07, p=.29), and its inclusion did not meaningfully improve model fit. Conclusions: Although neighborhood deprivation has been linked to adaptive outcomes among medically complex pediatric populations, it did not significantly predict adaptive functioning in this sample. Research with larger clinical samples of pediatric patients with CHD is necessary. Understanding neighborhood level factors can improve access to early intervention services, facilitate monitoring of high-risk patients, and mitigate adaptive and neurodevelopmental challenges later in life.