Age, sex, and multi-morbidity stratified mortality risk estimates for adults with cerebral palsy to inform clinical decision making

Abstract

BackgroundWhile research has provided key insights into mortality rates and risks for individuals with cerebral palsy (CP), clinically useable mortality risk estimates remain unreported for adults with CP, especially by key patient-level factors. ObjectiveThe objective of this study was to generate clinically useable mortality risk estimates among adults with CP to inform clinical decision making. MethodsThis retrospective cohort study, using a fee-for-service Medicare database, identified adults ≥18-years-old with CP from 01/01/2008-12/31/2010 and followed through 12/31/2019 for death. Mortality risk at 1-, 3-, 5-, and 9-year intervals were selected based on common clinical length of time to reasonably benefit from preventive care. Sex-stratified analyses assessed risk estimates by narrow age group (18-25/26-34/35-44/45-54/55-64/65-74/≥75 years old) and multi-morbidity group (Whitney Comorbidity Index score 0-2/3/4-6/≥7). ResultsOf 24,767 adults with CP, n=12,962 were men (mean [SD] age=48.3 [15.0] years) and n=11,805 were women (age=49.7 [15.8] years). Loss to follow-up was rare. 1-year risk was similar between men and women (3.4% vs. 3.3%), but increased slightly more for men than women through 9-years (30.1% vs. 28.0%). As expected, the mortality risk increased with older age and higher WCI scores. The probability of death (and survival) is presented per age and multi-morbidity group for men and women with CP. ConclusionsMortality risk estimates were reported at clinically relevant intervals by age, sex, and multi-morbidity status. This information can be used to weigh harm-to-benefit ratios of screening and treatment strategies based on mortality expectancy estimates.