社会健康决定因素包括父母职业、家庭收入和社区环境，这些因素对健康和患病儿童的认知结果具有预测能力；然而，在小儿肿瘤学领域，很少有研究探讨这种关系。本研究利用经济困难指数（EHI）来测量社区社会经济环境，预测接受共形辐射治疗的脑肿瘤患儿的认知结果。该研究纳入了241名接受共形光子辐射治疗（54-59.4 Gy）的脑室管膜瘤、低级别胶质瘤或颅咽管瘤患儿（52%女性、79%白人、放疗时年龄为7.76±4.98岁），在接下来的十年里完成了系列认知评估（智商[IQ]、阅读、数学、适应功能）。对六个美国人口普查区的经济困难指数得分进行计算，得出总体EHI得分：失业率、赡养比、受教育程度、收入、拥挤的住房和贫困。同时，还衍生出了已有文献中确立的社会经济地位（SES）测量指标。相关与非参数检验表明，EHI变量与其他SES度量具有适度的方差共享。收入、失业和贫困与个体SES测量重叠最多。线性混合模型分析，控制性别、放疗时年龄和肿瘤位置，发现EHI变量在基线和随着时间IQ和数学变化中预测了所有认知变量，EHI整体和贫困是最一致的预测因素。较高的经济困难与较低的认知成绩相关。社区层面的社会经济条件测量有助于了解小儿脑肿瘤幸存者的长期认知和学术结果。未来需要研究贫困的驱动力以及经济困难对其他灾害性疾病的儿童的影响。©作者2023年。由牛津大学出版社代表神经肿瘤学协会出版。保留所有权利。如需获得许可，请发送电子邮件至：journals.permissions@oup.com。

Social determinants of health including parental occupation, household income, and neighborhood environment are predictors of cognitive outcomes among healthy and ill children; however, few pediatric oncology studies have investigated this relationship. This study utilized the Economic Hardship Index (EHI) to measure neighborhood-level social and economic conditions to predict cognitive outcomes among children treated for brain tumors with conformal radiation therapy (RT).241 children treated on a prospective, longitudinal, phase II trial of conformal photon RT (54-59.4 Gy) for ependymoma, low-grade glioma, or craniopharyngioma (52% female, 79% White, age at RT= 7.76±4.98 years) completed serial cognitive assessments (intelligence quotient [IQ], reading, math, adaptive functioning) for ten years. Six US census tract-level EHI scores were calculated for an overall EHI score: unemployment, dependency, education, income, crowded housing, and poverty. Established socioeconomic status (SES) measures from the extant literature were also derived.Correlations and nonparametric tests revealed EHI variables share modest variance with other SES measures. Income, unemployment, and poverty overlapped most with individual SES measures. Linear mixed models, accounting for sex, age at RT, and tumor location, revealed EHI variables predicted all cognitive variables at baseline and change in IQ and math over time, with EHI overall and poverty most consistent predictors. Higher economic hardship was associated with lower cognitive scores.Neighborhood-level measures of socioeconomic conditions can help inform understanding of long-term cognitive and academic outcomes in survivors of pediatric brain tumors. Future investigation of poverty's driving forces and the impact of economic hardship on children with other catastrophic diseases is needed.© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.