418 - Association Between Child Functioning and Blood Pressure Among US Children Aged 8-17: NHANES 2021-2023

Publication Number: 1401.418

Emma Yang, Cohen Children's Medical Center, New Hyde Park, NY, United States; Mahie Abdullah, Cohen Children's Medical Center, New Hyde Park, NY, United States; Meghana Karan, Cohen Children's Medical Center, New Hyde Park, NY, United States; Rachel Frank, Northwell Health, NEW HYDE PARK, NY, United States; Suzanne Vento, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Pamela Singer, Cohen Children's Medical Center, Cedarhurst, NY, United States; Laura Castellanos, Cohen Children's Medical Center, New Hyde Park, NY, United States; Abby M. Basalely, Cohen Children's Medical Center, NEW HYDE PARK, NY, United States; Carol L. Shen, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Christine Sethna, Cohen Children's Medical Center, New Hyde Park, NY, United States

Background: Pediatric hypertension affects 3-5% of US children, with elevated blood pressure (BP) affecting an additional 13-18%. Hypertensive children experience cognitive impairments, behavioral difficulties, and psychosocial challenges, with 28% receiving special education services. However, no studies have examined associations between BP and functional difficulties using standardized instruments in a nationally representative sample. The National Health and Nutrition Examination Survey (NHANES) Child Functioning Module (CFM) provides a reliable assessment across cognitive, self-care, behavioral, and psychosocial domains.

Objective: This study aimed to examine associations between functional difficulties across multiple domains and BP in US children.

Design/Methods: Analysis included children 8-17 years from NHANES 2021-2023 who completed the CFM and had three casual BP measurements. Functional difficulties were assessed across nine domains: self-care, learning, remembering, concentrating, accepting change, controlling behavior, making friends, anxiety, and depression. According to the CFM Disability Indicator, participants who responded, "a lot of difficulty," "cannot do at all," or "daily" to at least one of the domains were defined as "with disabilities." Primary outcomes were the systolic BP (SBP) index, diastolic BP (DBP) index, and hypertensive BP. Linear and logistic regression models examined associations using complex survey design procedures, adjusting for sex, household reference person's education, age, body mass index z-score, and poverty index ratio.

Results: Analysis included 1,378 children representing 40,969,032 individuals nationally. Mean age was 12.49 years; 52.1% were male. Overall, 17.1% had disability and 3.6% had HTN. Disability status had no significant association with HTN (p=0.08). However, difficulty learning (p=0.04), accepting change (p=0.04), and controlling behavior (p=0.03) were associated with HTN when comparing children with no difficulty to those with severe difficulties. Difficulty controlling behavior was associated with SBP index. Multiple domains were associated with the DBP index, including disability, self-care, learning, remembering, accepting change, controlling behavior, making friends, and depression. (See Table).

Conclusion(s): Specific functional difficulties in cognitive, behavioral, and psychosocial domains were significantly associated with HTN and BP indices among US children. Functional assessment using the CFM may identify children at increased cardiovascular risk and inform screening protocols. Longitudinal research is needed to establish temporal relationships.

Table 1. Associations between functional difficulties across multiple domains and BP outcomes in US children aged 8-17 years.
Regression models adjusted for sex, household reference person's education, age, body mass index (BMI) z-score, and poverty index ratio (PIR). SBP index = systolic blood pressure index; DBP index = diastolic blood pressure index; BP = blood pressure.