Effects of accumulated host, social and environmental exposures on early childhood educational outcomes

Abstract

Background: Persistent disparities in academic performance may result from a confluence of adverse exposures accruing disproportionately to specific subpopulations.Objective: To investigate how multiple exposures experienced over time affect early childhood educational outcomes.Methods: We link geocoded North Carolina birth data for non-Hispanic white (NHW) and non-Hispanic black (NHB) children to blood lead surveillance data and end-of-grade (EOG) test scores at 4th grade (n = 65,151). We construct a local, spatial index of racial isolation (RI) for NHB at the block group. We fit race-stratified multi-level models of EOG scores regressed on birthweight percentile for gestational age, blood lead level, maternal smoking, economic disadvantage, and neighborhood RI exposures, adjusting for maternal- and child-level covariates and neighborhood median household income.Results: NHB children were more likely than NHW children to be economically disadvantaged (80% vs. 40%), live in block groups with elevated RI (46% vs. 5%), have higher blood lead levels (4.6 vs. 3.7 µg/dL), and lower birthweight percentile for gestational age (39% vs. 51%). Higher birthweight percentile was associated with higher reading and math EOG scores. Economic disadvantage was associated with decrements in reading scores of 2.23 (1.94, 2.52) and 2.61 (2.41, 2.80) points among NHB and NHW, respectively. NHB children with blood lead levels >10 µg/dL had reading scores 1.82 (1.16, 2.49) points lower than NHB children with blood levels of <1 µg/dL. NHW children with blood levels >10 µg/dL had reading scores 1.38 (0.74, 2.02) points lower than NHW children with blood levels of <1 µg/dL. NHB children in neighborhoods in the highest quintile of RI had reading scores 1.54 (0.74, 2.34) points lower than NHB children in neighborhoods in the lowest RI quintile. Results were similar for mathematics scores.Conclusion: Key adverse host, environmental, and social exposures accrue disproportionately to NHB children, resulting in lower EOG scores.