Peterson MD, Ryan JM, Hurvitz EA, Mahmoudi E. Chronic Conditions in Adults With Cerebral Palsy. JAMA. 2015;314(21):2303-2305. doi:10.1001/jama.2015.11025
Adults with cerebral palsy (CP) represent an increasing population whose health status and health care needs are poorly understood.1 Mortality records reveal that death due to ischemic heart disease and cancer is higher among adults with CP2; however, there have been no national surveillance efforts to track disease risk in this population. We examined estimates of chronic conditions in a population-representative sample of adults with CP.
We used the full-year consolidated and medical conditions files for 9 years (2002-2010) of the Medical Expenditure Panel Survey (MEPS). The MEPS is an ongoing, nationally representative survey of the US civilian, noninstitutionalized population, conducted annually by the Agency for Healthcare Research and Quality.3 Data are collected by interviews with a single respondent for the household; the survey has mean response rates of 60%. The survey has been reviewed and approved by the Westat institutional review board, established under a multiproject assurance granted by the Office for Protection from Research Risks; the requirement for informed consent was waived.
Adjustments were made for the complex survey design of the MEPS. Adults were identified as participants with congenital or infantile CP if an International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis code of 343 was associated with an office-based, hospital outpatient, or emergency department visit, a hospital inpatient stay, or a prescription medication.
Age-adjusted prevalence rates for 8 chronic conditions were evaluated in adults with and without CP, a subset of the priority condition section defined by a US Department of Health and Human Services workgroup and selected to reflect lifestyle-related behaviors: diabetes, asthma, hypertension, other heart conditions (including cardiovascular disease, myocardial infarction, angina, and other cardiovascular conditions), stroke, emphysema, joint pain, and arthritis. For each, a logistic regression model was fitted, adjusting for age, sex, weight status, race/ethnicity, marital status, education, income, type of health insurance, physical and mental health, physical activity, disability, metropolitan statistical area, and geographic location. All analyses were completed using Stata version 13 (StataCorp), with 2-sided 95% confidence intervals and P < .01 to determine significance.
Of the 207 615 adults included, 1015 had CP. Participants with CP vs without CP differed on many characteristics, including age (58.2 vs 45.4 years, respectively), male sex (65.9% vs 51.7%), and white race (92.7% vs 69.0%) (Table 1).
Age-adjusted prevalence rates of all chronic conditions were significantly greater among adults with CP vs without CP, including diabetes (9.2% vs 6.3%, respectively), asthma (20.7% vs 9.4%), hypertension (30.0% vs 22.1%), other heart conditions (15.1% vs 9.1%), stroke (4.6% vs 2.3%), emphysema (3.8% vs 1.4%), joint pain (43.6% vs 28.0%), and arthritis (31.4% vs 17.4%) (P < .001 for all comparisons; Table 1).
The adjusted odds ratios were significantly different for all conditions except diabetes and ranged from 1.32 (95% CI, 1.04-1.67) for hypertension to 2.03 (95% CI, 1.39-2.97) for emphysema. Age, sex, weight, physical disability, overall health, and physical activity were also associated with chronic conditions (Table 2).
In this population-based sample, adults with CP had significantly higher odds of chronic diseases compared with adults without CP, raising important questions about preventable health complications in this population.
Accelerated functional losses are a concern in the aging CP population. A large percentage of individuals who were once mobile eventually stop ambulating due to fatigue, inefficiency of gait, and/or muscle and joint pain.4 The current findings demonstrated that level of mobility impairment was strongly associated with chronic conditions.
This study was limited by the inability to determine cause-effect relationships between CP and chronic conditions; reliance on self-report data from a household member; and borderline acceptable (60%) response rates. The sample of adults with CP may not be entirely representative of the total population of adults with CP. Approximately half of adults with CP reported having a minor or no disability, suggesting that the group was particularly high functioning.
Future efforts are needed to better understand the health care use associated with chronic conditions for persons with CP and to characterize the relationships among mobility impairments, sedentary lifestyles, and chronic conditions.
Corresponding Author: Mark D. Peterson, PhD, MS, University of Michigan Hospital and Health Systems, 325 E Eisenhower Pkwy, Ann Arbor, MI 48108 (firstname.lastname@example.org).
Author Contributions: Drs Peterson and Mahmoudi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: Peterson, Mahmoudi.
Drafting of the manuscript: Peterson, Ryan, Mahmoudi.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Peterson, Mahmoudi.
Obtained funding: Peterson.
Administrative, technical, or material support: Peterson, Ryan.
Study supervision: Peterson, Hurvitz.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: Dr Peterson’s work was funded by grant 1KO1 HD074706 from the National Institutes of Health.
Role of the Funder/Sponsor: The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.