Infants From “Low Opportunity” Neighborhoods More Likely to Develop ROP

Social determinants of health (SDOH) can significantly influence the outcomes of children with retinopathy of prematurity (ROP), a disease that requires frequent screening and monitoring and can lead to vision-threatening complications. In a recent study, researchers from three top pediatric institutions—Boston Children’s Hospital, Massachusetts Eye and Ear and Children’s Hospital of Philadelphia—examined the relationship between ROP and a novel indicator of neighborhood conditions called the Child Opportunity Index (COI), to help identify children at high risk of developing the disease. They found that the prevalence of ROP (including cases that warrant treatment) was higher in children from very low-opportunity neighborhoods, primarily due to increased prematurity. The findings were reported in American Journal of Ophthalmology.  Infants from low-opportunity neighborhoods had lower birth weights and gestational ages, as well as a higher incidence of ROP, including cases that warrant intervention. Photo: Don W. Lyon, OD. Click image to enlarge. The researchers define COI as a measure encompassing 44 neighborhood characteristics vital for children's well-being. “COI index scores are organized into three domains that collectively shape child development: education, health and environment, and social and economic,” they explained in their paper on the work. COI is scored on a 1-100 range and neighborhoods are ordered into five groups: very low (<20), low (20 to <40), moderate (40 to <60), high (60 to <80), or very high (>80) opportunity. Infant census tracts were derived from residential addresses and linked to the COI by year of birth.A total of 2,468 infants who underwent screening for ROP between 2012 and 2021 at the neonatal intensive care units of the three institutions were included. Residential census tracts were used to determine the overall and domain-specific COI scores for each child, linked by year of birth. The primary analysis used the overall COI score, while secondary analyses focused on specific COI subdomains: education, health and environment and socioeconomic domain.It was found that infants from low-opportunity neighborhoods had lower birth weights (1026g vs. 1130g) and gestational ages  (27.8 weeks vs. 28.5 weeks) compared to those from very high-opportunity neighborhoods, and also a higher incidence of ROP, including cases that warrant intervention.“Our findings, using a novel measure specifically designed to assess childhood opportunity, are consistent with prior investigations that explored the impact of nationhood conditions on ROP using the Area Deprivation Index,” the authors wrote in their paper. “Importantly, this research extends previous work by demonstrating potential downstream consequences of neighborhood adversity and highlighting prematurity as a mediating factor.”It is plausible that adverse environmental factors, such as neighborhoods with higher pollution levels and limited access to green spaces, play an unseen role during the prenatal period, contributing to prematurity and ROP, the authors wrote in their paper.Other metrics included in the health and environment domain are health insurance coverage rate and density of non-profit healthcare organizations, as surrogates for neighborhood healthcare access. As an example, a previous study found that infants insured with Medicaid tend to be sicker and are more likely to have treatment-warranted ROP.Neighborhood-level factors, such as access to care, employment and health literacy may present challenges to routine follow-up visits that are critical in monitoring disease progression. Greater awareness of these barriers to care may help enable interventions to improve outcomes for infants with ROP.“Our findings support the important role of residential context for children with ROP and emphasize the need for future studies to explore how variation in neighborhood opportunity, particularly for health and environment conditions, may influence long-term outcomes in RO,” the research team concluded. “Neighborhood indices such as the COI may play an increasingly important role in identifying children at increased risk for vision-threatening conditions and enabling targeted interventions.” Click here for the journal source. Altamirano F, Hoyek S, Carlson K, et al. Association of childhood neighborhood opportunity with retinopathy of prematurity neighborhood opportunity and retinopathy of prematurity. Amer J Ophthalmol. July 10, 2025. [Epub ahead of print.]