The Association of Urbanicity with Cognitive Development at Five Years of Age in Preterm Children

OBJECTIVE: To determine the association of urbanicity, defined as living in an urban area, with cognitive development at five years of age in preterm children who were free of any disabilities or neurodevelopmental delays. DESIGN: Prospective population-based cohort. SETTING: French regional Loire Infant Follow-up Team (LIFT) network. PARTICIPANTS: Included in the study were 1738 surviving infants born between March 2003 and December 2008 before 35 weeks of gestational age. At two years of age, the children were free of any disabilities and neurodevelopmental delays and were living in the Pays de la Loire region from their birth to five years of age. MAIN OUTCOME MEASURES: The cognitive development at five years of age was evaluated with the Global School Adaptation score (GSA). The urbanicity of the residence for each child was classified into three groups: urban, quasi-rural, and rural area. RESULTS: Quantile regression approaches were used to identify a significant association between urbanicity and the GSA score at five years of age (adjusting for child and family characteristics). We found that the negative impact of urbanicity on the GSA score was more important for the lower quantile of the GSA scores. CONCLUSIONS: Urbanicity was significantly associated with cognitive neurodevelopment at five years of age in preterm children born before 35 weeks of gestation. Complementary results additionally suggest that this relation could be mediated at the residence level by a high socioeconomic deprivation level. If these results are confirmed, more personalized follow-ups could be developed for preterm children. Further studies are needed to finely identify the contextual characteristics of urbanicity that underlie this association.