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Original Investigation
May 3, 2021

Association of Local Variation in Neighborhood Disadvantage in Metropolitan Areas With Youth Neurocognition and Brain Structure

Author Affiliations
  • 1USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
  • 2Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles
  • 3Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles
  • 4Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
  • 5USC Dornsife Spatial Sciences Institute, University of Southern California, Los Angeles
  • 6Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
JAMA Pediatr. Published online May 3, 2021. doi:10.1001/jamapediatrics.2021.0426
Key Points

Question  Is neighborhood disadvantage associated with differences in youth neurocognition and brain structure after accounting for family socioeconomic status and does this association vary across US metropolitan areas?

Findings  In this cross-sectional study of 8598 children, neighborhood disadvantage was associated with worse neurocognitive performance and with lower total cortical surface area and subcortical volume. These associations were similar across the United States and were attributed to local differences in neighborhood disadvantage within metropolitan areas.

Meaning  Findings from this study suggest that local variations in neighborhood disadvantage are an environmental risk factor for youth neurocognitive performance and brain structure across the US, and thus improving the neighborhood context may be a promising approach to achieving better short- and long-term health and development for children and adolescents.


Importance  Neighborhood disadvantage is an important social determinant of health in childhood and adolescence. Less is known about the association of neighborhood disadvantage with youth neurocognition and brain structure, and particularly whether associations are similar across metropolitan areas and are attributed to local differences in disadvantage.

Objective  To test whether neighborhood disadvantage is associated with youth neurocognitive performance and with global and regional measures of brain structure after adjusting for family socioeconomic status and perceptions of neighborhood characteristics, and to assess whether these associations (1) are pervasive or limited, (2) vary across metropolitan areas, and (3) are attributed to local variation in disadvantage within metropolitan areas.

Design, Setting, and Participants  This cross-sectional study analyzed baseline data from the Adolescent Brain and Cognitive Development (ABCD) Study, a cohort study conducted at 21 sites across the US. Participants were children aged 9.00 to 10.99 years at enrollment. They and their parent or caregiver completed a baseline visit between October 1, 2016, and October 31, 2018.

Exposures  Neighborhood disadvantage factor based on US census tract characteristics.

Main Outcomes and Measures  Neurocognition was measured with the NIH Toolbox Cognition Battery, and T1-weighted magnetic resonance imaging was used to assess whole-brain and regional measures of structure. Linear mixed-effects models examined the association between neighborhood disadvantage and outcomes after adjusting for sociodemographic factors.

Results  Of the 11 875 children in the ABCD Study cohort, 8598 children (72.4%) were included in this analysis. The study sample had a mean (SD) age of 118.8 (7.4) months and included 4526 boys (52.6%). Every 1-unit increase in the neighborhood disadvantage factor was associated with lower performance on 6 of 7 subtests, such as Flanker Inhibitory Control and Attention (unstandardized Β = −0.5; 95% CI, −0.7 to −0.2; false discovery rate (FDR)–corrected P = .001) and List Sorting Working Memory (unstandardized Β = −0.7; 95% CI, −1.0 to −0.3; FDR-corrected P < .001), as well as on all composite measures of neurocognition, such as the Total Cognition Composite (unstandardized Β = −0.7; 95% CI, −0.9 to −0.5; FDR-corrected P < .001). Each 1-unit increase in neighborhood disadvantage was associated with lower whole-brain cortical surface area (unstandardized Β = −692.6 mm2; 95% CI, −1154.9 to −230.4 mm2; FDR-corrected P = .007) and subcortical volume (unstandardized Β = −113.9 mm3; 95% CI, −198.5 to −29.4 mm3; FDR-corrected P = .03) as well as with regional surface area differences, primarily in the frontal, parietal, and temporal lobes. Associations largely remained after adjusting for perceptions of neighborhood safety and were both consistent across metropolitan areas and primarily explained by local variation in each area.

Conclusions and Relevance  This study found that, in the US, local variation in neighborhood disadvantage was associated with lower neurocognitive performance and smaller cortical surface area and subcortical volume in young people. The findings demonstrate that neighborhood disadvantage is an environmental risk factor for neurodevelopmental and population health and enhancing the neighborhood context is a promising approach to improving the health and development of children and adolescents.

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