Abstract
BackgroundThere is a controversy regarding the existence of a socio-economic gradient for cerebral palsy. Perinatal emergencies and preterm birth increase the risk for the offspring to develop cerebral palsy. The aim of this study was to investigate the association of socio-economic indicators with cerebral palsy (CP) and the role of perinatal health as mediator of this association.MethodsRegister study of a national cohort of 805,543 children born 1987–93, including 1,437 children with cerebral palsy that were identified in hospital discharge data from national registers. Socio-economic indicators of the household were taken from the Census of 1985. Logistic regression and chi-square analyses of linearity were used to test hypotheses.ResultsThere was a linear association between the incidence of CP (excluding cases caused by registered injuries or malformations) as well as of major perinatal indicators and the socio-economic status (SES) of the household of the mother (p < 0.001). Children in households with low SES had a higher odds ratio of CP (OR 1.49 [95% C.I. 1.16–1.91]) compared with high SES after adjustment for demographic confounders. This OR decreased to 1.36 (1.05–1.71) after adjustment for perinatal indicators with preterm birth as the most important mediating variable.ConclusionThis study suggests that there is a continuous socio-economic gradient for CP in Sweden. Further studies in more complete populations of children with cerebral palsy are needed to confirm this. Perinatal complications seem to mediate some of this gradient.
Highlights
There is a controversy regarding the existence of a socio-economic gradient for cerebral palsy
There were 0.03 children per 1000 with cerebral palsy (CP) associated with severe head injuries, 0.21 per 1000 with CP associated with a malformation syndrome leaving 1.55 per 1000 with an "unspecified" CP, 1.79 in boys and 1.29 in girls
There was a linear association of unspecified CP with socio-economic status (SES) (p < 0.001; excluding unclassified SES)(Table 1)
Summary
There is a controversy regarding the existence of a socio-economic gradient for cerebral palsy. The aim of this study was to investigate the association of socio-economic indicators with cerebral palsy (CP) and the role of perinatal health as mediator of this association. Many European societies report considerable socio-economic differences in child health [1]. Sweden is no exception, reporting significant socio-economic gradients for major child health problems such as perinatal health, injuries and asthma [2]. There is conflicting evidence in the literature regarding socio-economic differences in families that give birth to children that develop CP [3]. The only Swedish study up to date reported a slightly higher risk for CP in offspring of mothers with a high socio-economic status (SES) compared with low SES [4]. In contrast studies from the UK [3,5] and Ireland [6] have reported a higher risk of (page number not for citation purposes)
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