Shared Physiologic Pathways Among Comorbidities for Adults With Cerebral Palsy

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.

Prevalence and incidence of chronic conditions among adults with cerebral palsy: A systematic review and meta‐analysis

“…28,29,[31][32][33][34] The prevalence of cancer among adults with intellectual disability from one study was 4.9%. 26 The prevalence of metastatic cancer was 0.6%. 33 The cumulative incidence of cancer was 0.9% and the incidence rate was 1.03 cases per 1000 person years.…”

“…Four reports provided data on the same conditions from the same samples; two reported data on obesity, hypercholesterolaemia, and hypertension from the same sample 24,25 and two reported data on epilepsy from the same sample. 26,27 Therefore, we did not include data from two reports. 25,27 Where two reports described identical data on several conditions, we only included data from one report.…”

“…25,27 Where two reports described identical data on several conditions, we only included data from one report. 26,[28][29][30]…”

5-year risk of “adult-onset” chronic diseases during childhood and adolescent transitioning for individuals with cerebral palsy

“…Collectively, these factors increase the risk for an accelerated development of an array of chronic diseases that are typically associated with older adults, as well as mental health disorders. For example, epidemiologic studies among 18–30 year olds with cerebral palsy have documented an elevated prevalence of diseases impacting cardiorespiratory, metabolic, kidney, and liver organ systems, as well as osteoarthritis, cancer, and depression ( Whitney et al, 2021 , Whitney et al, 2018 ), all of which gets worse with older age ( Whitney et al, 2021 ) and contributes to the high mortality burden for individuals with cerebral palsy ( Hemming et al, 2006 , Ryan et al, 2019 , Stevens et al, 2022 , Whitney et al, 2021 ).…”

Post-Fracture Inpatient and Outpatient Physical/Occupational Therapy and Its Association with Survival among Adults with Cerebral Palsy

“…The design and implementation of acute care/rehabilitation PT/OT depends in part on several patient-level factors, such as issues with fracture healing, pain, and the ability to perform and tolerate therapies. Adults with CP have long-standing issues with pain, function, and medical complexity, which may be exacerbated by a fracture [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. These factors may alter the initiation and volume of PT/OT sessions and the duration (i.e., number of days) that inpatient PT/OT services are applied in the acute care/rehabilitation setting.…”