Comparing risks of cerebral palsy in births between Australian Indigenous and non‐Indigenous mothers

Abstract

AIM To compare proportions of live births subsequently described as having cerebral palsy (CP), the distributions of associated impairments, and the causes of postneonatal CP between Aboriginal and Torres Strait Islander (Indigenous) and non-Indigenous populations in Australia.METHOD Data from statutory birth records and CP registers for the 1996 to 2005 birth cohort in Queensland, Western Australia, and the Northern Territory were stratified by Indigenous status and whether the CP was acquired pre/perinatally or postneonatally. Relative risks associated with Indigenous status were estimated and the distributions of causes of postneonatal CP compared.RESULTS Indigenous births had a relative risk of 4.9 (95% confidence interval [CI] 3.0-7.9) for postneonatal CP but only of 1.42 (95% CI 1.2-1.7) for pre/perinatal CP. Almost half of postneonatal CP in Indigenous infants resulted from infection, whereas for non-Indigenous infants the most frequent cause was cerebrovascular accident. The impairments of Indigenous CP and of postneonatally acquired CP tended to be more numerous and more severe.INTERPRETATION Indigenous children are at significantly greater risk of CP, particularly postneonatal CP. The predominant cause of postneonatal CP in non-Indigenous children has shifted to cerebrovascular accident over time; however, infections followed by head injury are still the most frequent causes in Indigenous infants.In Australia, health outcomes tend to be less favourable among persons claiming Aboriginal and/or Torres Strait Islander heritage (Indigenous) than in the non-Indigenous. Based on 2006 census data, estimates of proportions with disability requiring assistance with a core activity were almost twice as high for Indigenous Australians as for nonIndigenous Australians. 1 This discrepancy is echoed in the rate of disability among students in South Australian schools based on allocation of resources for children with special needs: 13.9% in Aboriginal students compared with 6.6% in non-Aboriginals. 2 The proportion of births subsequently described as having cerebral palsy (CP) is no exception, with 1980 to 1999 data from the Western Australian CP Register showing that the 5.6% of Western Australian births to Indigenous mothers accounted for 10.7% (144 out of 1350) of all CP. 3 Even though higher proportions of disability in the Indigenous population are consistently reported, CP is likely to be under-ascertained in this group for several reasons. Indigenous Australians tend to be more accepting of developmental differences in their children and less inclined to stigmatize them as different from other children, preferring not to seek a medical diagnosis unless there is a clear practical reason. 2 Furthermore, a history of children being removed from Indigenous families by governmental agencies has given these families cause to be mistrustful of the motives of the medical community. Indigenous families also tend to be more mobile than the non-Indigenous which, combined with being less likely to seek medical intervent...

A special supplement: findings from the Australian Cerebral Palsy Register, birth years 1993 to 2006

“…A further 175 children (5.6%) had an acquired brain injury as a result of a recognized event that occurred between 28 days and 2 years after birth, a rate of 1.2 per 10 000 live births (95% CI 0.6–2.6). The most frequent cause of brain injury in this postneonatal group was a cerebrovascular accident, either spontaneous or associated with surgery or cardiac complications; infections (viral or bacterial) were the next most frequent cause (this is discussed further in Blair et al., this issue).…”

“…The first, more common type of register, which is the model primarily chosen by CP registers in Australia, is typically less labour intensive. With appropriate birth registration or census data, estimates can be made of prevalence, evaluation of trends in prevalence, and/or severity (see the Australian Cerebral Palsy Register Group 5 and Reid et al, 6 both this issue), and antecedent factors can be assessed for their potential impact on CP risk (see Blair et al 7 and Reid et al, 8 both this issue). Furthermore, these registers are useful in describing a clinical and demographic profile of CP (see deLacy et al 9,10 and Blair et al, 11 all this issue) across geographical regions and periods.…”

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

“…7,10,21 Post-neonatal cerebral palsy in high-income countries is mainly due to head injury, especially cerebrovascular accident, whereas infections are the second most frequent cause. 31,32 In contrast, infections are the major cause of postneonatal cases of cerebral palsy in low- and middle-income countries. In our study of a low-income country, cerebral malaria and seizures were the main postneonatal causes of cerebral palsy.…”

Cerebral palsy after assisted reproductive technology: a cohort study

“…17 Data from Aboriginal children were excluded as CP may be underascertained in Aboriginal children. 18 Also, Aboriginal births are underrepresented in the ART population -6% of Western Australian births are classified as Aboriginal, based on maternal Aboriginal status, but less than 0.5% of females using ART are Aboriginal. 17 …”