Comorbidity Clusters Among Adults With Cerebral Palsy: A Latent Class Analysis

Abstract

IntroductionAdults with cerebral palsy (CP) are at risk for early multi-morbidity onset, but little is known about the composition of multi-morbidity profiles or how these profiles present across adulthood. The objective of this study was to identify multi-morbidity profiles and association with mortality among adults with CP. MethodsThis retrospective cohort study used a random 20% fee-for-service Medicare database from 01/01/2008-12/31/2019 from adults ≥18 years old with CP. Latent class analyses using four-class models were conducted within each age cohort (young adults 18-39, middle adulthood 40-64, and older adults ≥65 years) to determine patterns of 30 comorbidities defined using ICD-9 codes, identified from 01/01/2008-12/31/2010, and their association with mortality through 12/31/2019 (up to 11 years of follow-up); statistical analysis was performed in 2023. ResultsThree classes were relatively consistent in the composition of comorbidities across young (n=7,020), middle (n=13,554), and older (n=4,193) cohorts: (1) “Low Morbidity” (low proportion of all comorbidities) representing 50.1% (young), 41.4% (middle), and 30.9% (older) of the cohorts; (2) “Neurological Multi-Morbidity” (e.g., epilepsy, intellectual disabilities) representing 26.0% (young), 26.6% (middle), and 14.7% (older); and “Complex Multi-Morbidity” (e.g., cardiorespiratory, nutritional, musculoskeletal, neurological) representing 26.0% (young), 26.6% (middle), and 14.7% (older). The fourth class varied by young (“Mental Health Disorders”), middle (“Hypertension”), and older (“Hypertension and Osteoarthritis”) age cohorts. Compared to the “Low Morbidity” class, other classes had an increased mortality rate for each age cohort (HR range, 1.34-5.58, all P<0.001). ConclusionsFindings provide insight into varied multi-morbidity profiles and associations with mortality across the life course for adults with CP.