Abstract
Objective: Aging with cerebral palsy is accompanied by a declining health and function status across neurological and non-neurological systems. There is a need to understand the shared pathophysiology among comorbidities for adults with cerebral palsy, to inform clinical assessment and guidelines for interventions to improve healthful aging. To begin defining multimorbidity, this study identified the most common comorbidity combinations and their association with mortality among a representative sample of adults with cerebral palsy.Methods: Data from 2016 to 2018 were used from a random 20% sample from the fee-for-service Medicare database. Adults ≥18 years with cerebral palsy and 25 neurological and non-neurological comorbidities were obtained from 2016. Principal component (PC) analysis identified the most common comorbidity combinations, defined as individual PCs. Cox regression estimated the hazard ratio (HR) of 2-year mortality including all PCs and demographics in a single model. To facilitate comparisons, PC scores were transformed into quintiles (reference: lowest quintile).Results: Among the 16,728 adults with cerebral palsy, the most common comorbidity combinations (PCs) in order were: cardiorespiratory diseases, dysphagia, and fluid/electrolyte disorders; metabolic disorders (e.g., diabetes, renal disease, hypertension); neurologic-related disorders (e.g., dementia, cerebrovascular disease); gastrointestinal issues; and orthopedic-related disorders. During the 2-year follow-up, 1,486 (8.9%) died. In the adjusted model, most PCs were associated with an elevated mortality rate, especially the first PC (5th quintile HR = 3.91; 95%CI = 3.29–4.65).Discussion: This study identified the most common comorbidity combinations for adults with cerebral palsy, many of them were deadly, which may inform on the underlying pathophysiology or shared characteristics of multimorbidity for this population.
Highlights
Neurological, functional, metabolic, and psychosocial aspects can manifest in multiple ways for children with cerebral palsy, and collectively increase risk for a variety of morbidities as these children become adults
This study identified the most common comorbidity combinations among adults with cerebral palsy with and without co-occurring epilepsy and/or intellectual disabilities, advancing the knowledge of what multimorbidity looks like for this population, and what it may mean for survival
Some comorbidity combinations were less obvious, and may inform on new shared pathophysiologic pathways among comorbidities not previously regarded as established knowledge in the field, such as dysphagia and myocardial infarction, or the comorbidities present in PC3 for the entire sample
Summary
Neurological, functional, metabolic, and psychosocial aspects can manifest in multiple ways for children with cerebral palsy, and collectively increase risk for a variety of morbidities as these children become adults. Many morbidities can be prevented, delayed, or better clinically managed; yet, the field lacks evidence-based approaches to monitor morbidities for adults with cerebral palsy. To address this need, the Whitney Comorbidity Index (WCI) was recently developed [15] and validated [14], which is a simple, clinical-friendly tool designed to monitor health status for adults with cerebral palsy. The WCI score is calculated by summing the presence of 27 morbidities across neurological and nonneurological systems, which captures the unique multimorbidity profiles for adults with cerebral palsy better than other currently available methods [15]. While the WCI provides a novel basis to inform clinical decision making, it is a quantitative approach to defining multimorbidity profiles, and provides no evidence on the shared pathophysiology among comorbidities
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