Neighborhood Deprivation and Ambulatory Function Among Children in the Cerebral Palsy Research Network Registry in Washington State

Abstract

Neighborhood Deprivation and Ambulatory Function Among Children in the Cerebral Palsy Research Network Registry in Washington StateDeborah L Grenard Chair of Supervisory Committee:Daniel A. Enquobahrie Epidemiology Objective This study investigated the association between neighborhood-level resources and ambulatory function among children enrolled in the Cerebral Palsy Research Network Registry at Seattle Children’s Hospital.Methods: A total of 1,242 children enrolled in the Cerebral Palsy Research Network (CPRN) clinical registry at Seattle Children’s Hospital were included in the analysis. The exposure of interest was the Area Deprivation Index (ADI) associated with the patient’s home address. The outcome was ambulatory function as determined by Gross Motor Functional System Classification (GMFCS): I-III ambulatory and IV-V non-ambulatory. Robust Poisson regression was used to calculate Relative Risks (RR) and corresponding 95% confidence intervals. Results: Of the study population, 47% were female and 53% were identified as white. The regression analysis found that for each increase in ADI decile, the RR of not being ambulatory was 1.04 [1.01, 1.07], indicating a 40% increased risk between the most and least disadvantaged neighborhoods. The RR remained unchanged after adjusting for travel to care and preterm birth. In a sensitivity analysis limited to enrollees living in King County, WA, the RR was 1.07 [1.02, 1.12], indicating that this association is not likely related to distance to care or urbanicity. Conclusion: Our findings demonstrate that ADI is associated with functional outcomes for persons with cerebral palsy. It highlights the need for further research on the influence of home community resources on functional outcomes in persons with cerebral palsy.