Cerebral palsy and socioeconomic status: a retrospective cohort study

Abstract

Aims: To study the relation between risk of cerebral palsy and socioeconomic status. Methods: A total of 293 children with a diagnosis of cerebral palsy out of 105 760 live births between 1 January 1982 and 31 December 1997 were identified from the special conditions sub-file of the West Sussex Computerised Child Health System. Results: There was a linear association between risk of cerebral palsy and socioeconomic status (SES) measured by the Registrar General's social class (RGSC) and enumeration district (ED) ranked into quintiles by the Townsend Deprivation Index derived from 1991 census data. Fifty one per cent and 30% of cases of cerebral palsy were statistically ''attributable'' to inequality in SES using the RGSC and ED quintile respectively. A linear association was also noted for singleton live births. The association between risk of cerebral palsy and ED quintile persisted in a logistic regression model that included birth weight and gestational age, although that between RGSC and cerebral palsy no longer reached conventional levels of statistical significance after adjustment. Conclusions: A strong association was observed between socioeconomic status and the risk of cerebral palsy, which was only partly accounted for by the known social gradients in birth weight and gestational age.T he negative impact of socioeconomic deprivation has been shown for many aspects of child mortality and morbidity.1-3 The relation between socioeconomic status (SES) and the risk of cerebral palsy is not clear. An observed association between SES and cerebral palsy might suggest aetiological factors and pathways to prevention as well as being important in the planning of services and the allocation of resources.Low birth weight and prematurity are the strongest risk factors for cerebral palsy. 4 Given the observed association between these factors and SES, 5-7 an increased prevalence of cerebral palsy with low SES is expected. However, studies have produced conflicting results. Table 1 summarises the results of studies conducted in developed countries. In developing countries, there is a higher proportion of children with postnatally acquired cerebral palsy with a more clearly established socioeconomic gradient.West Sussex has a population of 750 000 with roughly 8000 births per year. Compared with national figures, fewer belong to ethnic minority groups and there is a lower rate of unemployment. However, there is a wide variation in SES with areas of deprivation. 8In the present study, population based, routinely collected data from West Sussex are used to: N Examine the relation between the prevalence of cerebral palsy and SES and between SES and the type and severity of cerebral palsy N Examine the degree to which any relation between SES and the prevalence of cerebral palsy is mediated by socioeconomic differences in birth weight and gestation.

Desempenho funcional de crianças com paralisia cerebral de níveis socioeconômicos alto e baixo

“…The relationship between SES and CP is not yet clear, however, it is believed that this association may suggest etiological factors and ways for prevention (13) , as well as impairments to motor development. Knowledge of the CP motor performance, from the analysis of the socioeconomic context, may represent an important tool for decision making in resource management and in the planning of services for these children.…”

Health Equity and Children's Rights

“…• access to a full continuum of health care without discrimination on the basis of (1) insurance, refugee, and/or immigration status, 51-58 (2) disabilities, 33,36,46 and/or (3) placement in foster care, the juvenile justice system, or other public venues 43,44,49,50 ;…”

“…If health disparities in the United States were eliminated, such that all children had the same risks of adverse outcomes as those of the most economically privileged, the prevalence of poor outcomes (eg, low birth weight, cerebral palsy, intellectual disabilities, psychological problems, child abuse, disabilities attributable to intentional and unintentional injuries) would be reduced by 60% to 70%. [32][33][34][35][36][37] Inequities in children's health also lead to disparities in adult health and wellbeing. [15][16][17][18][19] These inequities contribute to chronic adult illnesses and to the intergenerational perpetuation of poverty and ill health found in many communities (eg, obesity, diabetes, cardiovascular disease, poor educational outcomes, unemployment, poverty, early death, etc).…”

Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy

“…8,9 In West Sussex, England, low socioeconomic status was associated with elevated risk of cerebral palsy, and adjustment for birth weight and gestational age did not account for this increased risk. 8 The mechanism by which socioeconomic status and race interact to impact an individual's risk of cerebral palsy has not been adequately studied.…”

“…8,9 In West Sussex, England, low socioeconomic status was associated with elevated risk of cerebral palsy, and adjustment for birth weight and gestational age did not account for this increased risk. 8 The mechanism by which socioeconomic status and race interact to impact an individual's risk of cerebral palsy has not been adequately studied. To assess the relationship between ethnicity and low birth weight with respect to the prevalence of cerebral palsy, and to determine whether socioeconomic status impacts the risk of cerebral palsy within racial/ethnic groups, we studied a large, multiethnic population in California.…”