Whitney Comorbidity Index to monitor health status for adults with cerebral palsy: validation and thresholds to assist clinical decision making

Whitney, Daniel G.; Basu, Tanima

doi:10.1111/dmcn.14879

Cited by 20 publications

(53 citation statements)

References 28 publications

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“…For example, 1 out of 4 adults with cerebral palsy aged 18–30 years have multimorbidity, which is >3 times more prevalent than the general population of young adults ( 11 ), and continues to get worse with older age ( 12 ). Recent work suggests that multimorbidity for adults with cerebral palsy is a robust risk factor for premature mortality ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Shared Physiologic Pathways Among Comorbidities for Adults With Cerebral Palsy

2021

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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.

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Section: Introductionmentioning

confidence: 99%

Shared Physiologic Pathways Among Comorbidities for Adults With Cerebral Palsy

2021

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“…Medical conditions can be identified by specific International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes that are attached to claims. A description of data ascertainment of this cohort, variables, and the ICD-10-CM codes used to identify each medical condition, as well as a flow chart of inclusion/exclusion criteria for this cohort have been reported previously (19,24,25). Data are de-identified and the University Institutional Review Board approved this study as non-regulated.…”

Section: Methods Data Sourcementioning

confidence: 99%

The Association Between Kidney Disease and Mortality Among Adults With Cerebral Palsy—A Cohort Study: It Is Time to Start Talking About Kidney Health

Whitney

Oliverio

2021

Front. Neurol.

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Objective: Recent evidence shows that adults with cerebral palsy (CP) have an increased risk for kidney disease, but nothing is known about how kidney disease integrates with their overall health. To begin understanding the importance of kidney health, the objective was to determine if kidney disease is associated with mortality among adults with CP after accounting for comorbidities common to CP and kidney disease.Methods: Data from 2016 to 2018 from adults ≥18 years with CP were used from a random 20% sample fee-for-service Medicare database. Kidney disease in 2016 was ascertained as chronic kidney disease (CKD) stages 1–4, end stage kidney disease (ESKD), nephritic and nephrotic syndrome, and renal osteodystrophy. A modified version of the Whitney Comorbidity Index (modWCI) was used, which includes 24 comorbidities relevant to CP and kidney disease. Mortality rate ratio (MRR) through the year 2018 was estimated for each kidney disease and Cox regression estimated the hazard ratio (HR) of mortality after adjusting for demographics, co-occurring neurological conditions, and the modWCI.Results: Prevalence of kidney disease was 7.3% among 16,728 adults with CP. MRR was elevated for any kidney disease (MRR = 3.14; 95%CI = 2.76–3.58) and most subtypes (MRR = 2.21–3.56; all p < 0.05). The adjusted HR of mortality remained elevated for any kidney disease (HR = 1.25; 95%CI = 1.09–1.45) and ESKD (HR = 1.38; 95%CI = 1.10–1.74).Discussion: Kidney disease, especially ESKD, is associated with mortality among adults with CP independent of comorbidities that are relevant to CP and kidney disease. Findings suggest that nephrology care should be considered as part of routine clinical care for this population.

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“…The study by Whitney and Basu 1 contributes to the field of research on comorbidities and mortality in adults with CP, by showing the substantial health issues and the alarming high 2‐year mortality rate in this population. The study emphasizes the need for accessible and disability‐appropriate preventive care to ensure that adults with CP (and adults with disability in general) are granted equal access to healthcare services, as stated in the United Nations Convention of the Rights for People with Disabilities.…”

mentioning

confidence: 98%

“…Compared to adults without CP, adults with CP are at increased risk for a variety of conditions, for example diabetes, hypertension, stroke, and osteoporosis. Whitney and Basu 1 validated the recently developed Whitney Comorbidity Index (WCI) to predict mortality in adults with CP 2 . The authors presented a strong paper which is highly relevant for the adult CP population.…”

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confidence: 99%