Pediatric brain tumor survivors (PBTS) are vulnerable to post-treatment neurocognitive challenges, necessitating the identification of predictive factors. While the influence of neighborhood opportunity on cognitive development is recognized, the impact of these domains in PBTS remains underexplored. This study evaluated Childhood Opportunity Index (COI), a census tract-based metric reflecting social determinants of health and neighborhood resources, alongside neurological risk, as predictors of cognitive outcomes in PBTS. Additionally, specific COI dimensions were investigated.

A retrospective chart review of PBTS (n=161, M_age = 13.47, SD = 2.80), ≥ 2 years post-treatment and without neurodevelopmental delays before diagnosis, was conducted. Intellectual functioning (IF), perceptual reasoning (PR), processing speed (PS), verbal reasoning (VR), working memory (WM), and attention were analyzed in relation to the Neurological Predictor Scale (NPS) and the COI. The NPS measured cumulative tumor- and treatment-related neurological risk (0-11 scale), while the COI rated participants’ neighborhood opportunities (0-100 scale).

The mean COI rating was 61.88 (SD = 28.59), with 16.15% (n=26) and 66.46% (n=107) 1 SD below and above the sample mean, respectively. NPS scores ranged from 1 to 11 (M = 5.57, SD = 2.27). COI scores did not differ significantly by demographic or medical-related variables (p’s > .05). Higher COI scores corresponded with better performance on both IF and PR measures.

Moderation analyses indicated that the overall model predicting IF from COI, NPS, and their interaction was significant (R² = 0.25, F [3, 153] = 17.01, p < .001). There was a significant interaction between COI and NPS (b = -.04 , t = -2.01, p < .05) indicating greater disparity in IF based on COI at lower NPS scores and reduced differences in IF based on COI at higher NPS scores. A similar model predicting PR also was significant (R² = 0.17, F [3, 63] = 4.34, p < .01), with a significant COI-NPS interaction (b = -0.6, t = -.2.15, p < .05). COI-NPS interactions on PS, VR, WM, and attention were not significant (p’s > .05).

COI domains (i.e., education, health, social, economic) correlated with IF, VCI, PR, and PSI (p’s < .05). In multiple linear regression models, overall models significantly predicted cognitive outcomes (p’s < .05), though individual COI domains were not significant predictors of IF or PR. Instead, the overall COI had significant predictive power, suggesting a comprehensive neighborhood influence beyond individual domains.

Childhood neighborhood opportunity and neurological risk significantly interact to influence cognitive outcomes in PBTS. Notably, at lower NPS scores, greater disparities in IF and PR scores based on COI were evident, while at higher NPS scores, differences in IF and PR scores based on COI were less pronounced. Moreover, the overall COI, not individual dimensions, emerged as a predictor of IF and PR. These findings underscore the necessity for targeted screening and interventions to support PBTS from disadvantaged communities.