Cerebral palsy in Canadian Indigenous children

Abstract

Registry SES Socioeconomic status AIM To determine whether inequities in health outcomes for Indigenous Canadians are also present in cerebral palsy (CP) by comparing CP profiles between Indigenous and non-Indigenous children. METHOD Using the Canadian Cerebral Palsy Registry, we conducted a cross-sectional study. CP motor subtype, gross motor severity, comorbidities, perinatal adversity, preterm birth, and parental education were compared between 94 Indigenous (53 males, 41 females) and 1555 non-Indigenous (891 males, 664 females) children (all >5y). Multivariate analysis was done to analyze adverse CP factors, defined as CP gross motor severity and comorbidities. CP etiologies, either prenatal/perinatal or postnatal, were also compared. RESULTS Indigenous children with CP have higher odds of having low parental education (odds ratio [OR] 6.15, 95% confidence interval [CI] 3.36-11.3) and comorbidities (OR 4.46, 95% CI 1.62-12.3), especially cognitive (OR 4.52, 95% CI 2.27-9.05), communication (OR 2.66, 95% CI 1.54-4.61), and feeding (OR 2.25, 95% CI 1.33-3.83) impairment. Indigenous children also have higher CP gross motor severity (p=0.03). Indigenous children are also more likely to have nonaccidental head injury (n=4; OR 8.18, 95% CI 1.86-36.0) as the cause of their postnatal CP. INTERPRETATION Indigenous populations have worse health outcomes as a result of intergenerational impacts of colonization. Our study shows that Indigenous children with CP have increased comorbidities and higher CP gross motor severity, reinforcing the need for a multidisciplinary approach to management. Furthermore, targeted prevention programs against preventable causes of CP, such as non-accidental head injury, may be beneficial.

Social determinants of health for children with cerebral palsy and their families

“…An Australian study found that children with CP whose mothers belonged to a minority ethnicity were more likely to function if classified in GMFCS levels IV and V and have a severe comorbidity 14 . A Canadian study reported that children of Indigenous mothers were more likely to function if classified in GMFCS levels II to V compared to children with CP of non‐Indigenous mothers, with Indigenous mothers also reporting lower educational levels 22 . In one study from Sweden, children with CP from a foreign background were more likely to have difficulty communicating (described using the Communication Function Classification System) 23 .…”

“…The relationship between ethnicity and the health outcomes of children with CP is important. Across several countries, children with CP from Indigenous and minority ethnic groups are at increased risk of poorer health outcomes 14,22–24 . The potential causes for these outcomes are not clear and probably complex and multifactorial.…”

Leaving no one behind: Cerebral palsy in indigenous populations

“…2 With the advent of artificial intelligence, more solutions are bound to arise, such as the not-yet-public Med-PaLM2, Google's large language model to answer medical questions, achieving accuracies similar to clinicians. 3 Coupling these capabilities with the ever-growing availability of sensors and their data provides an unparalleled opportunity to perform personalized medicine and gain previously unavailable insights. Similarly, digital therapeutics, that is, therapeutic interventions driven by software, hold the promise to deliver care more broadly and for unmet needs.…”

“…Contributing factors to the aetiology of CP include adolescent pregnancy, preterm birth, low birthweight, and postnatal traumas. This increased risk has been established in indigenous populations in Ireland, Canada, 2 and Australia 3 …”

The importance of engagement with Indigenous peoples in health research

“…Overall, this study by Chen et al 1 addresses an important issue in Canadian Indigenous health, through an analysis of the Canadian Cerebral Palsy Registry. Ethnicity data were available for 94 Indigenous children compared with 1555 non‐Indigenous children.…”