Housing-Based Socioeconomic Status at Birth and Risk of Mental, Behavioral, and Developmental Disorders in a Population-Based Cohort.

Abstract

To evaluate whether the HOUsing-based SocioEconomic Status (HOUSES) index, a validated individual-level proxy derived from property data, predicts the risk of mental, behavioral, and developmental disorders (MBDDs). We performed a retrospective cohort study of live births (2010-2021) using the Rochester Epidemiology Project. The exposure, HOUSES index at birth, was categorized into quartiles (Q1 = lowest; Q4 = highest). The primary outcome was MBDD diagnosis by age 9. We used Cox proportional hazards models to assess risk, adjusting for prematurity. Of 79 444 children (median follow-up 6.2 years), 18 078 (22.8%) received an MBDD diagnosis. Risk increased in a dose-response manner as socioeconomic status decreased: compared with the highest quartile (Q4), adjusted hazard ratios (aHRs) were 1.11 (Q3), 1.21 (Q2), and 1.35 (95% CI 1.29-1.41) for Q1 (lowest). Comparing Q1 vs Q4, risks were pronounced for autism spectrum disorder (aHR 1.98; 95% CI 1.62-2.41), attention deficit hyperactivity disorder (aHR 1.60; 95% CI 1.43-1.80), stress-associated disorders (aHR 1.57; 95% CI 1.24-1.99), and developmental speech or language disorders (aHR 1.20; 95% CI 1.12-1.29). In time-varying analyses accounting for residential mobility, the overall risk for Q1 compared with Q4 increased further (HR 1.69; 95% CI 1.64-1.75). In addition, children in Q1 had higher emergency department utilization rates (incidence rate ratio 1.44; 95% CI 1.41-1.48) compared with Q4. Conversely, no significant difference was observed for inpatient admissions across quartiles. Housing-based socioeconomic status is a robust, independent predictor of MBDD diagnosis. The HOUSES index reflects social drivers of health associated with neurodevelopment, facilitating early identification of at-risk populations.