Place-Based Child Opportunity at Birth and Child Development from Infancy to Age 4.

OBJECTIVE: To evaluate whether the children's neighborhood quality, as a measure of place-based social determinants of health, is associated with the odds of developmental delay and developmental performance up to age 4 years.

STUDY DESIGN: Mothers of 5702 children from the Upstate KIDS Study, a longitudinal population-based cohort of children born from 2008 through 2010, provided questionnaire data and a subset of 573 children participated in a clinic visit. The Child Opportunity Index 2.0 (COI) was linked to home census tract at birth. Probable developmental delays were assessed by the Ages and Stages Questionnaire© up to 7 times between 4 and 36 months, and developmental performance was assessed via the Battelle Developmental Inventory at age 4 years.

RESULTS: In unadjusted models, higher neighborhood opportunity was protective against developmental delays and was associated with slightly higher development scores at age 4. After adjusting for family-level confounding variables, ten-point higher COI (on a 100-point scale) remained associated with a lower odds of any developmental delay (OR = .966, 95%CI = .940-.992), and specifically delays in the personal-social domain (OR = .921, 95%CI = .886-.958), as well as better development performance in motor (B = 0.79, 95%CI = 0.11-1.48), personal-social (B = 0.64, 95%CI = 0.003-1.28), and adaptive (B = 0.69, 95%CI = 0.04-1.34) domains at age 4.

CONCLUSIONS: Community-level opportunities are associated with some aspects of child development prior to school entry. A greater understanding of neighborhood quality may be helpful to pediatric providers to inform targeted developmental screening.