Health Disparities
Social determinants of health are related with brain health over a 2 year of follow-up, beyond lifestyle behaviors: insights from the ABCD project Cristina Cadenas-Sanchez* Cristina Cadenas-Sanchez Harold W. Kohl Marcus V. Nascimento-Ferreira Augusto César F. De Moraes
BACKGROUND: Social determinants of health may influence children’s health outcomes,
including psychological and cognitive well-being. Nevertheless, previous studies have
focused on cross-sectional associations rather than examining the potential effects of the
social determinants of health on brain health.
PURPOSE: To examine the longitudinal association between social determinants of health
and brain health over a 2-year follow-up period in children. Additionally, we aim to explore
the role of lifestyle factors on this association.
METHODS: We included 4,948 participants (aged 8-10 years, 52.4% boys) from the
Adolescent Brain Cognitive Development (ABCD) project. Social determinants of health
were measured using children’s opportunity index which comprises educational, health and
environmental opportunities. Grey matter volume of the hippocampus was assessed through
magnetic resonance imaging, and executive function (i.e., inhibition) was evaluated using
the flanker test. Lifestyle behaviors (i.e., physical activity, screen time, and sleep) were self-
reported through surveys. Participants were followed-up from study initiation (2016-2018) to
the second-year follow-up. Multilevel mixed-effects were used to estimate beta coefficient
and 95% confidence intervals (CIs). All the analyses were adjusted for age, sex, ethnicity, air
pollution, population density and their baseline measures. In an additional model, we further
adjusted for lifestyle behaviors.
RESULTS: Children categorized in the high and very high opportunity index presented
significantly greater hippocampal volume compared to their peers with low or
moderate opportunity levels (very high, beta coefficient=14.9, 95%CI=5.1-24.7 vs.
low, beta coefficient 7.9, 95%CI=-3.8-19.5; P < 0.001). A similar pattern was observed
for executive function, with children in the very high opportunity group demonstrating
superior inhibitory control compared to those in the lower opportunity group (very
high, beta coefficient=2.6, 95%CI=1.8-3.9 vs. low, beta coefficient 1.3, 95%CI=0.3-2.3;
P < 0.001). Notably, after adjusting for lifestyle behaviors, the results remained
consistent.
CONCLUSION: This study underscores the significant impact of childhood
opportunities on both hippocampal volume and executive function in children. Those
with high and very high opportunity indices exhibited notable advantages in brain
health compared to their counterparts with lower opportunities. Importantly, these
findings emphasize the enduring influence of social determinants on cognitive
outcomes. Understanding these relationships contributes valuable insights for
creating targeted interventions aimed at optimizing childhood brain development
and well-being.