Noncommunicable disease and multimorbidity in young adults with cerebral palsy

Daniel G Whitney; Edward A Hurvitz; Jennifer M Ryan; Maureen J Devlin; Michelle S Caird; Zachary P French; Elie C Ellenberg; Mark D Peterson

doi:10.2147/CLEP.S159405

Noncommunicable disease and multimorbidity in young adults with cerebral palsy

Clin Epidemiol. 2018 May 1:10:511-519. doi: 10.2147/CLEP.S159405. eCollection 2018.

Authors

Daniel G Whitney¹, Edward A Hurvitz¹, Jennifer M Ryan^{2

3}, Maureen J Devlin⁴, Michelle S Caird⁵, Zachary P French¹, Elie C Ellenberg¹, Mark D Peterson¹

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
² Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
³ Department of Clinical Sciences, Brunel University London, Uxbridge, UK.
⁴ Department of Anthropology, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.

Abstract

Purpose: Individuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP.

Methods: A clinic-based sample of adults (18-30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center. The prevalence and predictors of 13 NCDs were evaluated, including existing diagnoses or historical record of musculoskeletal, cardiometabolic, and pulmonary morbidities. The level of motor impairment was determined by the Gross Motor Function Classification System (GMFCS) and stratified by less vs more severe motor impairment (GMFCS I-III vs IV-V). Logistic regression was used to determine the odds of NCD morbidity and multimorbidity in adults with CP compared to adults without CP, and for GMFCS IV-V compared to GMFCS I-III in those with CP, after adjusting for age, sex, body mass index, and smoking.

Results: Adults with CP had a higher prevalence of osteopenia, osteoporosis, hypertension, myocardial infarction, hyperlipidemia, asthma, and multimorbidity compared to adults without CP, and higher odds of musculoskeletal (odds ratio [OR]: 6.97) and cardiometabolic morbidity (OR: 1.98), and multimorbidity (OR: 2.67). Adults with CP with GMFCS levels IV-V had a higher prevalence of osteopenia/osteoporosis, osteoarthritis, hypertension, other cardiovascular conditions, pulmonary embolism, and multimorbidity, and higher odds of musculoskeletal (OR: 3.41), cardiometabolic (OR: 2.05), pulmonary morbidity (OR: 1.42), and multimorbidity (OR: 3.45) compared to GMFCS I-III.

Conclusion: Young adults with CP have a higher prevalence of chronic NCDs and multimorbidity compared to young adults without CP, which is pronounced in those with more severe motor impairment. These findings reiterate the importance of early screening for prevention of NCDs in CP.

Keywords: cardiovascular disease; cerebral palsy; diabetes; multimorbidity; noncommunicable disease; osteoarthritis; osteoporosis; pulmonary disease.